Statistical flags indicate unusual patterns — not proof of fraud or wrongdoing. Read our methodology

Southcentral Foundation

Clinic/Center Community Health·Anchorage, AK·NPI: 1538378625SharePrint Report
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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:

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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.

These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.

Risk Assessment

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Bills $686.91 per claim for 99213 (Office/outpatient visit, est. patient, low-mod complexity) — 18.2× the national median of $37.81.

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Bills $676.66 per claim for 99214 (Office/outpatient visit, est. patient, mod-high complexity) — 12.7× the national median of $53.41.

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Bills $679.31 per claim for 97110 (Therapeutic exercises, each 15 min) — 27.7× the national median of $24.49.

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Billing in the top 1% nationally for 23 procedure codes: 99213, 99214, 97110.

This is a statistical summary, not an accusation. See our methodology.

Active Billing Period:2018-01→2024-11(83 months)
Sharp billing drop in final month

Total Paid

$130.3M

$130,283,487

Total Claims

192K

Beneficiaries

177K

1.1 claims/patient

Avg Cost/Claim

$679

#887 of 618K providers by total spending(top 0.1%)

🔍 Analysis

Provider Overview

Southcentral Foundation is a Clinic/Center Community Health provider based in Anchorage, AK. From the 2018–2024 period, this provider received $130.3M in Medicaid payments across 192K claims.

Why This Matters

This provider received $130.3M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 16,285 Medicaid beneficiaries for a full year at average per-enrollee costs.

↑ 33% growthsince first billing year

Monthly Spending Trend

Yearly Spending

2018
$16.0M
+15%
2019
$18.4M
-36%
2020
$11.8M
+47%
2021
$17.3M
+35%
2022
$23.3M
-5%
2023
$22.3M
-5%
2024
$21.2M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 28 distinct procedure codes. The top code (99213 (Office/outpatient visit, est. patient, low-mod complexity)) accounts for 76% of total spending.

99213Top 1%

Office/outpatient visit, est. patient, low-mod complexity

$99.6M

145K claims · 76.4%

Your Cost: $686.91/claim|Median: $37.81
18.2× median
99214Top 1%

Office/outpatient visit, est. patient, mod-high complexity

$20.5M

30K claims · 15.7%

Your Cost: $676.66/claim|Median: $53.41
12.7× median
97110Top 1%

Therapeutic exercises, each 15 min

$2.7M

4K claims · 2.1%

Your Cost: $679.31/claim|Median: $24.49
27.7× median
99393Top 1%

Preventive medicine, established patient, age 5-11

$1.3M

2K claims · 1.0%

Your Cost: $672.40/claim|Median: $74.82
9.0× median
99212Top 1%

Office/outpatient visit, low complexity

$1.3M

2K claims · 1.0%

Your Cost: $663.59/claim|Median: $25.06
26.5× median
99442Top 1%

Telephone E/M by physician, 11-20 minutes

$1.2M

2K claims · 0.9%

Your Cost: $593.60/claim|Median: $22.44
26.4× median
99392Top 1%

Preventive medicine, established patient, age 1-4

$907K

1K claims · 0.7%

Your Cost: $674.46/claim|Median: $75.18
9.0× median
99441Top 1%

Telephone E/M by physician, 5-10 min

$898K

1K claims · 0.7%

Your Cost: $619.12/claim|Median: $13.30
46.5× median
99391Top 1%

Preventive medicine, established patient, infant (under 1)

$535K

664 claims · 0.4%

Your Cost: $806.26/claim|Median: $69.35
11.6× median
99443Top 1%

Telephone E/M by physician, 21-30 min

$405K

689 claims · 0.3%

Your Cost: $587.74/claim|Median: $32.55
18.1× median
99394Top 1%

Preventive medicine, established patient, age 12-17

$371K

549 claims · 0.3%

Your Cost: $676.42/claim|Median: $80.15
8.4× median
99381Top 1%

Preventive visit, new patient, infant (<1 yr)

$156K

183 claims · 0.1%

Your Cost: $854.05/claim|Median: $73.46
11.6× median
0002ATop 1%

COVID-19 vaccine admin, Pfizer, 2nd dose

$131K

166 claims · 0.1%

Your Cost: $788.53/claim|Median: $36.70
21.5× median
0072ATop 1%

$58K

70 claims · 0.0%

Your Cost: $825.81/claim|Median: $39.57
20.9× median
99215Top 1%

Office/outpatient visit, high complexity

$54K

82 claims · 0.0%

Your Cost: $656.24/claim|Median: $74.09
8.9× median
0001ATop 1%

COVID-19 vaccine admin, Pfizer, 1st dose

$52K

68 claims · 0.0%

Your Cost: $760.47/claim|Median: $33.72
22.6× median
97161Top 5%

Physical therapy evaluation, low complexity

$31K

132 claims · 0.0%

Your Cost: $234.42/claim|Median: $47.89
4.9× median
97530Top 1%

Therapeutic activities, each 15 min

$22K

56 claims · 0.0%

Your Cost: $396.11/claim|Median: $33.11
12.0× median
0071ATop 1%

$21K

24 claims · 0.0%

Your Cost: $876.50/claim|Median: $38.71
22.6× median
98926Top 1%

$18K

36 claims · 0.0%

Your Cost: $511.50/claim|Median: $22.66
22.6× median
98925Top 1%

$18K

32 claims · 0.0%

Your Cost: $554.12/claim|Median: $13.42
41.3× median
0004ATop 1%

$11K

14 claims · 0.0%

Your Cost: $808.00/claim|Median: $35.62
22.7× median
92567Top 5%

$9K

108 claims · 0.0%

Your Cost: $78.94/claim|Median: $11.50
6.9× median
97112Top 1%

Therapeutic procedure, neuromuscular reeducation, per 15 minutes

$8K

15 claims · 0.0%

Your Cost: $517.20/claim|Median: $20.04
25.8× median
97140Top 1%

Manual therapy techniques, per 15 minutes

$3K

16 claims · 0.0%

Your Cost: $205.38/claim|Median: $16.79
12.2× median
91307Normal range

$0

221 claims · 0.0%

Your Cost: $0.00/claim|Median: $0.01
91300Normal range

COVID-19 vaccine (Pfizer), first dose

$0

732 claims · 0.0%

Your Cost: $0.00/claim|Median: $0.01
90832Normal range

Psychotherapy, 30 minutes

$0

14 claims · 0.0%

Your Cost: $0.00/claim|Median: $41.28

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