Altamed Health Services Corp.
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $416.11 per claim for T1015 (Clinic visit/encounter, all-inclusive), which is 3.4× the national median of $121.16.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 3 procedure codes: T1015 at 3.4× median, 96110 at 5.5× median.
High Cost Per Claim
Average payment per claim is much higher than peers billing the same procedures.
Spending Spike
Experienced a dramatic increase in billing over a short period.
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:
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.
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.
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.
Spending Spike
Spending Spike means this provider experienced a dramatic, sudden increase in billing over a short period. Legitimate causes include new contracts or expanded services, but this pattern also appears in billing fraud ramp-ups.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Bills $416.11 per claim for T1015 (Clinic visit/encounter, all-inclusive) — 3.4× the national median of $121.16.
Bills $49.64 per claim for 96110 (Developmental screening, per standardized instrument) — 5.5× the national median of $9.10.
Billing above the 90th percentile for 2 procedure codes simultaneously.
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 24 providers in this specialty
This provider's total spending of $305.8M is at the 90th percentile among 24 Clinic/Center Federally Qualified Health Center (FQHC) providers.
Above 90th percentile for this specialty — higher spending than 21 of 24 peers
Total Paid
$305.8M
$305,796,831
Total Claims
2.5M
Beneficiaries
1.9M
1.3 claims/patient
Avg Cost/Claim
$122
#238 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Altamed Health Services Corp. is a Clinic/Center Federally Qualified Health Center (FQHC) provider based in Los Angeles, CA. From the 2018–2024 period, this provider received $305.8M in Medicaid payments across 2.5M claims.
Why This Matters
This provider received $305.8M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 38,224 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 98% of total spending.
$298.9M
718K claims
$416.11
$121.16
Clinic visit/encounter, all-inclusive
$298.9M
718K claims · 97.7%
$723K
52K claims
$13.89
$74.82
Preventive medicine, established patient, age 5-11
$723K
52K claims · 0.2%
$688K
47K claims
$14.56
$75.18
Preventive medicine, established patient, age 1-4
$688K
47K claims · 0.2%
$609K
32K claims
$19.24
$80.15
Preventive medicine, established patient, age 12-17
$609K
32K claims · 0.2%
$592K
28K claims
$21.14
$47.08
Ophthalmological exam, comprehensive, established patient
$592K
28K claims · 0.2%
$553K
64K claims · 0.2%
$412K
8K claims
$49.64
$9.10
Developmental screening, per standardized instrument
$412K
8K claims · 0.1%
Psychotherapy, 45 minutes
$284K
14K claims · 0.1%
$266K
15K claims
$18.09
$69.35
Preventive medicine, established patient, infant (under 1)
$266K
15K claims · 0.1%
$237K
104K claims
$2.28
$6.61
Screening audiometry, pure tone, air only
$237K
104K claims · 0.1%
$218K
103K claims
$2.12
$7.18
Influenza virus vaccine, quadrivalent, preservative-free, IM
$218K
103K claims · 0.1%
$162K
8K claims
$21.21
$59.72
Ophthalmological exam, comprehensive, new patient
$162K
8K claims · 0.1%
$157K
3K claims
$48.04
$36.70
COVID-19 vaccine admin, Pfizer, 2nd dose
$157K
3K claims · 0.1%
Psychiatric diagnostic evaluation
$128K
4K claims · 0.0%
$115K
2K claims · 0.0%
$115K
6K claims
$17.75
$33.72
COVID-19 vaccine admin, Pfizer, 1st dose
$115K
6K claims · 0.0%
$115K
1K claims
$82.04
$72.71
Preventive medicine, established patient, age 18-39
$115K
1K claims · 0.0%
$111K
450K claims
$0.25
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$111K
450K claims · 0.0%
$109K
98K claims
$1.11
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$109K
98K claims · 0.0%
Psychotherapy, 30 minutes
$89K
7K claims · 0.0%
$72K
182K claims
$0.40
$17.85
Immunization administration, first vaccine/toxoid, with counseling
$72K
182K claims · 0.0%
$71K
11K claims · 0.0%
$65K
10K claims · 0.0%
HPV vaccine, 9-valent
$62K
13K claims · 0.0%
$58K
13K claims · 0.0%
$55K
2K claims
$32.87
$81.92
Preventive visit, new patient, late childhood (5-11 yr)
$55K
2K claims · 0.0%
$49K
4K claims
$13.65
$121.58
Office or other outpatient consultation, moderate complexity
$49K
4K claims · 0.0%
$46K
6K claims · 0.0%
DTaP-HepB-IPV vaccine
$40K
6K claims · 0.0%
$39K
6K claims · 0.0%
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