Neighborhood Healthcare
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $6.2M (2019) to $22.7M (2020) — a 270% swing with $16.6M absolute change.
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:
Billing Swing
Billing Swing means this provider's total billing changed dramatically from one year to the next — increasing or decreasing by more than 200% with over $1M in absolute change. This could indicate a change in practice scope, a billing scheme ramping up, or legitimate growth.
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 $159.09 per claim for G2087 — 3.3× the national median of $48.10.
This is a statistical summary, not an accusation. See our methodology.
Compared to Clinic/Center, Federally Qualified Health Center (FQHC) Peers
Total spending distribution among 16 providers in this specialty
This provider's total spending of $124.9M is at the 25th percentile among 16 Clinic/Center, Federally Qualified Health Center (FQHC) providers.
Total Paid
$124.9M
$124,930,174
Total Claims
2.0M
Beneficiaries
1.6M
1.3 claims/patient
Avg Cost/Claim
$63
#946 of 618K providers by total spending(top 0.2%)
🔍 Analysis
Provider Overview
Neighborhood Healthcare is a Clinic/Center, Federally Qualified Health Center (FQHC) provider based in Escondido, CA. From the 2018–2024 period, this provider received $124.9M in Medicaid payments across 2.0M claims.
Why This Matters
This provider received $124.9M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 15,616 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 (T1015 (Clinic visit/encounter, all-inclusive)) accounts for 76% of total spending.
$95.3M
490K claims
$194.52
$121.16
Clinic visit/encounter, all-inclusive
$95.3M
490K claims · 76.3%
Anesthesia services
$16.1M
61K claims · 12.9%
$3.2M
512K claims
$6.34
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$3.2M
512K claims · 2.6%
Psychotherapy, 30 minutes
$2.8M
108K claims · 2.2%
$1.6M
113K claims
$13.88
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$1.6M
113K claims · 1.3%
$1.2M
8K claims
$138.07
$137.85
Other specified case management service, per 15 minutes
$1.2M
8K claims · 0.9%
$838K
71K claims
$11.73
$20.83
Chiropractic manipulative treatment, 3-4 spinal regions
$838K
71K claims · 0.7%
$543K
94K claims
$5.80
$25.06
Office/outpatient visit, low complexity
$543K
94K claims · 0.4%
Psychotherapy, 45 minutes
$541K
19K claims · 0.4%
$537K
28K claims
$19.40
$21.91
Federally qualified health center visit, mental health
$537K
28K claims · 0.4%
Psychiatric diagnostic evaluation
$441K
7K claims · 0.4%
$337K
35K claims · 0.3%
$238K
6K claims
$37.45
$66.78
Coordination of long-term care services, per month
$238K
6K claims · 0.2%
$161K
9K claims
$18.27
$22.44
Telephone E/M by physician, 11-20 minutes
$161K
9K claims · 0.1%
$118K
1K claims
$106.34
$108.91
Psychiatric diagnostic evaluation with medical services
$118K
1K claims · 0.1%
$95K
11K claims · 0.1%
$94K
9K claims · 0.1%
$79K
8K claims · 0.1%
$69K
431 claims · 0.1%
$62K
8K claims
$7.71
$11.35
RHC/FQHC visit, psychiatric collaborative care model
$62K
8K claims · 0.0%
$60K
4K claims
$15.00
$57.85
Office/outpatient visit, new patient, low-mod complexity
$60K
4K claims · 0.0%
$38K
4K claims · 0.0%
$35K
2K claims
$14.20
$11.01
Paring or cutting of benign hyperkeratotic lesions, two to four
$35K
2K claims · 0.0%
$33K
7K claims
$4.61
$13.30
Telephone E/M by physician, 5-10 min
$33K
7K claims · 0.0%
$31K
4K claims · 0.0%
$29K
562 claims
$51.81
$74.09
Office/outpatient visit, high complexity
$29K
562 claims · 0.0%
$26K
886 claims
$28.93
$33.85
COVID-19 vaccine admin, Moderna, 2nd dose
$26K
886 claims · 0.0%
$23K
2K claims
$10.55
$40.11
Office/outpatient visit, new patient, low complexity
$23K
2K claims · 0.0%
$22K
1K claims
$16.90
$25.93
COVID-19 vaccine admin, Moderna, 1st dose
$22K
1K claims · 0.0%
$21K
817 claims
$25.22
$33.72
COVID-19 vaccine admin, Pfizer, 1st dose
$21K
817 claims · 0.0%
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