Central Valley Specialty Hospital INC
General Acute Care Hospital
Modesto, California
NPI: 1578989703
Risk Tier
Critical
Total Paid
$130.7M
$130,741,379
Total Claims
39K
Beneficiaries
27K
Avg Cost/Claim
$3,310.49
Active billing period: 80 months (2018-01 to 2024-08)
Statistical Fraud Flags (3)
Cost Outlier
Billing over 3× the national median for specific procedure codes.
Bills $25,140.79 per claim for 0120, which is 4.2× the national median of $5,968.57.
High Cost Per Claim
Average payment per claim is much higher than peers billing the same procedures.
High Claims Per Patient
Filing an unusually high number of claims per beneficiary compared to peers.
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