Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 3 procedure codes: H0031 at 17.6× median, 96116 at 53.8× median.
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.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Bills $1,692.32 per claim for H0031 (Mental health assessment by non-physician) — 17.6× the national median of $96.18.
Bills $2,510.99 per claim for 96116 (Neurobehavioral status examination, first hour) — 53.8× the national median of $46.64.
Bills $232.84 per claim for 96156 — 10.4× the national median of $22.36.
Billing in the top 1% nationally for 3 procedure codes: H0031, 96116, 96156.
This is a statistical summary, not an accusation. See our methodology.
Compared to Case Management Peers
Total spending distribution among 137 providers in this specialty
This provider's total spending of $350.1M is at the 75th percentile among 137 Case Management providers.
Total Paid
$350.1M
$350,102,592
Total Claims
2.4M
Beneficiaries
560K
4.3 claims/patient
Avg Cost/Claim
$146
#196 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Bhpn LLC is a Case Management provider based in Walnut Creek, CA. From the 2018–2024 period, this provider received $350.1M in Medicaid payments across 2.4M claims.
Important Context
- ℹ️This provider appears to operate as a fiscal intermediary or management organization, processing payments on behalf of many individual caregivers. High aggregate billing is expected for this type of entity.
Why This Matters
This provider received $350.1M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 43,762 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 12 distinct procedure codes. The top code (H2019 (Therapeutic behavioral services, per 15 min)) accounts for 51% of total spending.
$178.8M
1.2M claims
$154.81
$84.12
Therapeutic behavioral services, per 15 min
$178.8M
1.2M claims · 51.1%
$72.7M
473K claims
$153.54
$80.64
Mental health service plan development
$72.7M
473K claims · 20.8%
$39.6M
389K claims · 11.3%
$32.3M
255K claims
$126.84
$74.63
Behavioral health counseling & therapy, per 15 min
$32.3M
255K claims · 9.2%
$10.4M
6K claims
$1,692.32
$96.18
Mental health assessment by non-physician
$10.4M
6K claims · 3.0%
$10.0M
68K claims
$146.63
$83.88
Skills training & development, per 15 min
$10.0M
68K claims · 2.9%
$3.8M
1K claims
$2,510.99
$46.64
Neurobehavioral status examination, first hour
$3.8M
1K claims · 1.1%
$1.3M
6K claims
$199.65
$114.71
Comprehensive multidisciplinary evaluation
$1.3M
6K claims · 0.4%
$909K
40K claims
$22.95
$49.45
Speech/hearing/language treatment
$909K
40K claims · 0.3%
$280K
6K claims
$48.10
$74.36
Home care training, family; per 15 min
$280K
6K claims · 0.1%
$154K
5K claims
$30.04
$18.18
Self-care/home management training, per 15 minutes
$154K
5K claims · 0.0%
$32K
138 claims · 0.0%
Other Top Providers in California
View all →Los Angeles County Department of Mental Health
Clinic/Center, Mental Health (Including Community
$6.78B
County of Santa Clara
Community/Behavioral Health
$1.73B
County of Riverside
Community/Behavioral Health
$1.40B
City & County of San Francisco
Community/Behavioral Health
$1.34B
Los Angeles County Department of Public Health
Public Health or Welfare
$1.13B
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