County of Santa Clara
Community/Behavioral Health
San Jose, California
NPI: 1528263910
Risk Tier
Critical
Total Paid
$1.73B
$1,728,502,977
Total Claims
4.7M
Beneficiaries
1.6M
Avg Cost/Claim
$371.23
Active billing period: 82 months (2018-01 to 2024-10)
Statistical Fraud Flags (4)
Cost Outlier
Billing over 3× the national median for specific procedure codes.
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.
Disclaimer: Statistical flags indicate unusual billing patterns — they are not proof of fraud or wrongdoing. Some entities (government agencies, home care programs, hospitals) may legitimately bill at higher rates due to patient acuity, overhead costs, or specialized services. This report is generated from public HHS data and statistical analysis only. No clinical or investigative review has been performed.
Generated by OpenMedicaid | openmedicaid.org | Data: HHS 2018-2024