Los Angeles County Department of Mental Health
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $845.79 per claim for 99232 (Subsequent hospital care, per day, moderate complexity), which is 35.3× the national median of $23.99.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 72 procedure codes: 90837 at 4.6× median, H2019 at 5.0× 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:
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.
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 $393.12 per claim for 90837 (Psychotherapy, 60 minutes) — 4.6× the national median of $85.66.
Bills $1,318.49 per claim for S9484 (Crisis intervention mental health services, per hour) — 5.3× the national median of $249.51.
Bills $423.28 per claim for H2019 (Therapeutic behavioral services, per 15 min) — 5.0× the national median of $84.12.
Billing in the top 1% nationally for 10 procedure codes: 90837, 90834, 99232.
This is a statistical summary, not an accusation. See our methodology.
Compared to Clinic/Center, Mental Health (Including Community Mental Health Center) Peers
Total spending distribution among 44 providers in this specialty
This provider's total spending of $6.78B is at the 99th percentile among 44 Clinic/Center, Mental Health (Including Community Mental Health Center) providers.
Above 99th percentile for this specialty — higher spending than 43 of 44 peers
Total Paid
$6.78B
$6,778,483,867
Total Claims
30.9M
Beneficiaries
10.5M
2.9 claims/patient
Avg Cost/Claim
$220
#2 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Los Angeles County Department of Mental Health is a Clinic/Center, Mental Health (Including Community Mental Health Center) provider based in Los Angeles, CA. From the 2018–2024 period, this provider received $6.8B in Medicaid payments across 30.9M claims.
Important Context
- ℹ️This is a government entity that may serve as a fiscal agent for large populations. Government providers often bill at high volumes due to the scale of public programs they administer.
Why This Matters
This provider received $6.8B in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 847,310 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 (H2015 (Comprehensive community support services, per 15 min)) accounts for 40% of total spending.
$2.73B
12.9M claims
$210.78
$96.24
Comprehensive community support services, per 15 min
$2.73B
12.9M claims · 40.2%
$870.7M
4.3M claims
$201.48
$91.63
Psychosocial rehabilitation services, per 15 min
$870.7M
4.3M claims · 12.8%
$570.0M
3.6M claims
$159.04
$69.56
Targeted case management, per 15 min
$570.0M
3.6M claims · 8.4%
$552.3M
3.1M claims
$176.46
$62.69
Comprehensive medication services, per 15 min
$552.3M
3.1M claims · 8.1%
$499.3M
3.3M claims
$152.34
$80.64
Mental health service plan development
$499.3M
3.3M claims · 7.4%
Psychotherapy, 60 minutes
$368.0M
936K claims · 5.4%
$298.6M
226K claims
$1,318.49
$249.51
Crisis intervention mental health services, per hour
$298.6M
226K claims · 4.4%
$107.3M
253K claims
$423.28
$84.12
Therapeutic behavioral services, per 15 min
$107.3M
253K claims · 1.6%
$91.2M
375K claims
$243.02
$72.96
Prolonged office/outpatient E/M, each additional 15 min
$91.2M
375K claims · 1.3%
Psychotherapy, 45 minutes
$68.4M
210K claims · 1.0%
$66.9M
79K claims
$845.79
$23.99
Subsequent hospital care, per day, moderate complexity
$66.9M
79K claims · 1.0%
$58.2M
72K claims
$812.55
$841.93
Psychiatric health facility service, per diem
$58.2M
72K claims · 0.9%
$47.2M
130K claims
$362.79
$467.51
Behavioral health; short-term residential, per diem
$47.2M
130K claims · 0.7%
$39.8M
40K claims
$1,007.36
$74.09
Office/outpatient visit, high complexity
$39.8M
40K claims · 0.6%
$37.3M
172K claims
$216.93
$137.86
Behavioral health day treatment, per hour
$37.3M
172K claims · 0.6%
$37.2M
55K claims
$678.74
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$37.2M
55K claims · 0.5%
$33.1M
153K claims
$216.27
$56.90
Medication training and management, per 15 min
$33.1M
153K claims · 0.5%
$31.3M
92K claims
$339.76
$77.33
Family psychotherapy with patient, 50 min
$31.3M
92K claims · 0.5%
$25.3M
54K claims
$465.52
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$25.3M
54K claims · 0.4%
$24.2M
45K claims
$532.05
$150.51
Day habilitation, waiver; per 15 min
$24.2M
45K claims · 0.4%
$20.6M
44K claims
$466.67
$32.55
Telephone E/M by physician, 21-30 min
$20.6M
44K claims · 0.3%
$19.2M
76K claims
$252.73
$169.11
Community-based wrap-around services, per 15 min
$19.2M
76K claims · 0.3%
Psychotherapy, 30 minutes
$16.6M
81K claims · 0.2%
$16.0M
50K claims
$318.48
$55.04
Self-help/peer services, per 15 minutes
$16.0M
50K claims · 0.2%
$14.3M
36K claims
$396.20
$215.80
Crisis intervention service, per 15 minutes
$14.3M
36K claims · 0.2%
$14.3M
12K claims
$1,189.20
$35.30
Subsequent hospital care, per day, high complexity
$14.3M
12K claims · 0.2%
$14.1M
9K claims
$1,565.23
$51.25
Initial hospital care, per day, moderate complexity
$14.1M
9K claims · 0.2%
$8.3M
47K claims
$176.85
$357.16
Behavioral health; residential, per diem
$8.3M
47K claims · 0.1%
$8.3M
74K claims
$112.67
$99.21
Psychiatric diagnostic evaluation
$8.3M
74K claims · 0.1%
$7.0M
4K claims
$1,713.88
$67.32
Initial hospital care, per day, high complexity
$7.0M
4K claims · 0.1%
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