Natera Inc.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 4 procedure codes: 81479 at 7.2× median, 0060U at 1.8× 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:
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.
Advanced Detection Signals
Additional statistical tests from advanced fraud detection methods
These signals use advanced statistical methods including digit distribution analysis, change-point detection, and market concentration metrics. Learn more.
Risk Assessment
Bills $278.15 per claim for 81479 (Unlisted molecular pathology procedure) — 7.2× the national median of $38.66.
This is a statistical summary, not an accusation. See our methodology.
Compared to Clinical Medical Laboratory Peers
Total spending distribution among 88 providers in this specialty
This provider's total spending of $641.5M is at the 90th percentile among 88 Clinical Medical Laboratory providers.
Above 90th percentile for this specialty — higher spending than 79 of 88 peers
Total Paid
$641.5M
$641,511,860
Total Claims
7.3M
Beneficiaries
6.4M
1.1 claims/patient
Avg Cost/Claim
$88
#80 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Natera Inc. is a Clinical Medical Laboratory provider based in San Carlos, CA. From the 2018–2024 period, this provider received $641.5M in Medicaid payments across 7.3M claims.
Why This Matters
This provider received $641.5M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 80,188 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 (81420 (Fetal chromosomal aneuploidy genomic sequence analysis)) accounts for 47% of total spending.
$298.8M
1.2M claims
$256.26
$358.21
Fetal chromosomal aneuploidy genomic sequence analysis
$298.8M
1.2M claims · 46.6%
$108.0M
454K claims
$238.11
$158.72
Molecular pathology procedure, level nine
$108.0M
454K claims · 16.8%
$74.6M
542K claims
$137.62
$183.31
CFTR gene analysis, common variants
$74.6M
542K claims · 11.6%
$25.1M
89K claims · 3.9%
$19.2M
440K claims · 3.0%
$19.2M
554K claims · 3.0%
$12.1M
44K claims
$278.15
$38.66
Unlisted molecular pathology procedure
$12.1M
44K claims · 1.9%
$10.5M
152K claims · 1.6%
$9.0M
333K claims · 1.4%
$7.4M
35K claims · 1.2%
$6.4M
316K claims · 1.0%
$6.1M
490K claims · 1.0%
$5.5M
371K claims · 0.9%
$5.1M
332K claims · 0.8%
$3.0M
10K claims · 0.5%
$3.0M
302K claims · 0.5%
$3.0M
11K claims · 0.5%
$2.9M
334K claims · 0.4%
$2.7M
26K claims · 0.4%
$2.7M
299K claims · 0.4%
$2.7M
302K claims · 0.4%
$2.4M
12K claims · 0.4%
$2.3M
315K claims · 0.4%
$1.8M
31K claims · 0.3%
$1.3M
20K claims · 0.2%
$1.0M
25K claims · 0.2%
$865K
29K claims · 0.1%
$521K
5K claims · 0.1%
$431K
14K claims · 0.1%
$411K
11K claims · 0.1%
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