County of Santa Clara
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $338.93 per claim for H2017 (Psychosocial rehabilitation services, per 15 min), which is 3.7× the national median of $91.63.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 34 procedure codes: H2015 at 4.5× median, H2017 at 3.7× median.
Unusually High Spending
This provider's total payments are significantly above the median for their specialty.
High Cost Per Claim
Average payment per claim is much higher than peers billing the same procedures.
Statistical flags are not proof of wrongdoing. Some entities (government agencies, home care programs) may legitimately bill at high rates. Hospitals, government entities, and large care organizations may legitimately bill at higher rates due to patient acuity, overhead costs, or specialized services. Read our methodology.
Red Flags Explained
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Each flag represents a statistical test that identified unusual billing patterns. Here's what each flag on this provider means in plain English:
Cost Outlier
Cost Outlier means this provider charges significantly more per claim than other providers billing the same procedure codes. This could indicate upcoding, inflated charges, or specialized services that justify higher costs.
Rate Outlier
Rate Outlier means this provider charges above the 90th percentile for multiple different procedure codes simultaneously. While one high-cost code could reflect specialization, consistently high rates across many codes may indicate systematic overbilling.
Unusually High Spending
Unusually High Spending means this provider's total Medicaid payments are significantly above the median for their specialty. This doesn't necessarily indicate fraud — high volume practices and those serving complex populations may legitimately bill more.
High Cost Per Claim
High Cost Per Claim means each individual claim from this provider costs significantly more than what other providers charge for the same services. This could indicate upcoding (billing for more expensive services than provided) or legitimate specialized care.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Bills $429.25 per claim for H2015 (Comprehensive community support services, per 15 min) — 4.5× the national median of $96.24.
Bills $222.59 per claim for T1017 (Targeted case management, per 15 min) — 3.2× the national median of $69.56.
Bills $386.95 per claim for H2010 (Comprehensive medication services, per 15 min) — 6.2× the national median of $62.69.
Billing in the top 1% nationally for 11 procedure codes: 90837, 99215, 90834.
This is a statistical summary, not an accusation. See our methodology.
Compared to Community/Behavioral Health Peers
Total spending distribution among 218 providers in this specialty
This provider's total spending of $1.73B is at the 99th percentile among 218 Community/Behavioral Health providers.
Above 99th percentile for this specialty — higher spending than 215 of 218 peers
Total Paid
$1.73B
$1,728,502,977
Total Claims
4.7M
Beneficiaries
1.6M
2.9 claims/patient
Avg Cost/Claim
$371
#10 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
County of Santa Clara is a Community/Behavioral Health provider based in San Jose, CA. From the 2018–2024 period, this provider received $1.7B in Medicaid payments across 4.7M claims.
Important Context
- ℹ️This is a government entity that may serve as a fiscal agent for large populations. Government providers often bill at high volumes due to the scale of public programs they administer.
Why This Matters
This provider received $1.7B in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 216,062 Medicaid beneficiaries for a full year at average per-enrollee costs.
Monthly Spending Trend
Yearly Spending
Procedure Breakdown
Cost per claim compared to national benchmarks
This provider bills for 30 distinct procedure codes. The top code (H2015 (Comprehensive community support services, per 15 min)) accounts for 52% of total spending.
$890.2M
2.1M claims
$429.25
$96.24
Comprehensive community support services, per 15 min
$890.2M
2.1M claims · 51.5%
$275.5M
1.2M claims
$222.59
$69.56
Targeted case management, per 15 min
$275.5M
1.2M claims · 15.9%
$182.8M
472K claims
$386.95
$62.69
Comprehensive medication services, per 15 min
$182.8M
472K claims · 10.6%
$100.5M
296K claims
$338.93
$91.63
Psychosocial rehabilitation services, per 15 min
$100.5M
296K claims · 5.8%
$51.4M
103K claims
$497.10
$467.51
Behavioral health; short-term residential, per diem
$51.4M
103K claims · 3.0%
Psychotherapy, 60 minutes
$41.1M
80K claims · 2.4%
$36.9M
79K claims
$467.40
$84.12
Therapeutic behavioral services, per 15 min
$36.9M
79K claims · 2.1%
$22.3M
72K claims
$308.48
$80.64
Mental health service plan development
$22.3M
72K claims · 1.3%
$17.7M
8K claims
$2,275.07
$249.51
Crisis intervention mental health services, per hour
$17.7M
8K claims · 1.0%
$16.0M
40K claims
$397.17
$72.96
Prolonged office/outpatient E/M, each additional 15 min
$16.0M
40K claims · 0.9%
$12.0M
9K claims
$1,350.74
$74.09
Office/outpatient visit, high complexity
$12.0M
9K claims · 0.7%
$11.9M
23K claims
$520.85
$56.90
Medication training and management, per 15 min
$11.9M
23K claims · 0.7%
$11.2M
10K claims
$1,125.25
$841.93
Psychiatric health facility service, per diem
$11.2M
10K claims · 0.6%
Psychotherapy, 45 minutes
$9.4M
24K claims · 0.5%
$8.4M
20K claims
$430.01
$96.18
Mental health assessment by non-physician
$8.4M
20K claims · 0.5%
$7.8M
8K claims
$939.59
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$7.8M
8K claims · 0.5%
$6.5M
9K claims
$693.79
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$6.5M
9K claims · 0.4%
$6.0M
7K claims
$879.88
$215.80
Crisis intervention service, per 15 minutes
$6.0M
7K claims · 0.3%
Psychiatric diagnostic evaluation
$2.8M
19K claims · 0.2%
Psychotherapy, 30 minutes
$2.4M
9K claims · 0.1%
$1.7M
14K claims
$126.78
$31.37
Oral medication administration, direct observation
$1.7M
14K claims · 0.1%
$1.6M
6K claims
$251.83
$137.86
Behavioral health day treatment, per hour
$1.6M
6K claims · 0.1%
Telephone E/M by physician, 21-30 min
$1.5M
2K claims · 0.1%
$1.4M
4K claims
$399.15
$357.16
Behavioral health; residential, per diem
$1.4M
4K claims · 0.1%
$1.4M
4K claims · 0.1%
$1.3M
3K claims
$420.64
$55.04
Self-help/peer services, per 15 minutes
$1.3M
3K claims · 0.1%
$1.3M
2K claims
$555.89
$108.91
Psychiatric diagnostic evaluation with medical services
$1.3M
2K claims · 0.1%
$1.1M
3K claims
$350.74
$114.71
Comprehensive multidisciplinary evaluation
$1.1M
3K claims · 0.1%
$879K
2K claims
$423.48
$77.33
Family psychotherapy with patient, 50 min
$879K
2K claims · 0.1%
$772K
2K claims
$396.16
$25.06
Office/outpatient visit, low complexity
$772K
2K claims · 0.0%
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