Sac Health System
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 7 procedure codes: T1015 at 2.6× median, G0467 at 6.6× 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
▼
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 $143.52 per claim for G0467 (Federally qualified health center visit, mental health) — 6.5× the national median of $21.91.
Bills $66.61 per claim for 90677 — 5.1× the national median of $12.96.
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, Community Health Peers
Total spending distribution among 8 providers in this specialty
This provider's total spending of $260.2M is at the 99th percentile among 8 Clinic/Center, Community Health providers.
Above 99th percentile for this specialty — higher spending than 7 of 8 peers
Total Paid
$260.2M
$260,215,579
Total Claims
3.3M
Beneficiaries
2.4M
1.3 claims/patient
Avg Cost/Claim
$80
#317 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Sac Health System is a Clinic/Center, Community Health provider based in San Bernardino, CA. From the 2018–2024 period, this provider received $260.2M in Medicaid payments across 3.3M claims.
Why This Matters
This provider received $260.2M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 32,526 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 88% of total spending.
$227.8M
718K claims
$317.40
$121.16
Clinic visit/encounter, all-inclusive
$227.8M
718K claims · 87.5%
Anesthesia services
$21.5M
54K claims · 8.3%
Psychotherapy, 45 minutes
$1.9M
41K claims · 0.7%
$1.9M
449K claims
$4.14
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$1.9M
449K claims · 0.7%
Antepartum care only, 4-6 visits
$1.3M
21K claims · 0.5%
Psychotherapy, 60 minutes
$1.2M
15K claims · 0.5%
$873K
239K claims
$3.66
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$873K
239K claims · 0.3%
Psychotherapy, 30 minutes
$621K
17K claims · 0.2%
$346K
8K claims
$44.71
$74.09
Office/outpatient visit, high complexity
$346K
8K claims · 0.1%
$307K
17K claims
$17.89
$57.85
Office/outpatient visit, new patient, low-mod complexity
$307K
17K claims · 0.1%
$282K
77K claims
$3.66
$137.85
Other specified case management service, per 15 minutes
$282K
77K claims · 0.1%
Psychiatric diagnostic evaluation
$271K
4K claims · 0.1%
$236K
2K claims
$143.52
$21.91
Federally qualified health center visit, mental health
$236K
2K claims · 0.1%
$169K
103K claims
$1.65
$66.78
Coordination of long-term care services, per month
$169K
103K claims · 0.1%
$168K
3K claims · 0.1%
$128K
32K claims
$4.02
$25.06
Office/outpatient visit, low complexity
$128K
32K claims · 0.0%
$117K
7K claims
$16.96
$47.08
Ophthalmological exam, comprehensive, established patient
$117K
7K claims · 0.0%
$109K
1K claims
$79.10
$108.91
Psychiatric diagnostic evaluation with medical services
$109K
1K claims · 0.0%
Tdap vaccine
$106K
5K claims · 0.0%
$103K
847 claims · 0.0%
$101K
23K claims
$4.48
$69.35
Preventive medicine, established patient, infant (under 1)
$101K
23K claims · 0.0%
$101K
4K claims
$27.31
$59.72
Ophthalmological exam, comprehensive, new patient
$101K
4K claims · 0.0%
$79K
11K claims
$7.50
$84.03
Office/outpatient visit, new patient, mod-high complexity
$79K
11K claims · 0.0%
$71K
4K claims
$17.04
$73.46
Preventive visit, new patient, infant (<1 yr)
$71K
4K claims · 0.0%
$57K
34K claims
$1.68
$7.18
Influenza virus vaccine, quadrivalent, preservative-free, IM
$57K
34K claims · 0.0%
$32K
611 claims
$53.19
$77.33
Family psychotherapy with patient, 50 min
$32K
611 claims · 0.0%
$27K
12K claims
$2.30
$9.10
Developmental screening, per standardized instrument
$27K
12K claims · 0.0%
HPV vaccine, 9-valent
$27K
2K claims · 0.0%
$26K
925 claims
$27.72
$39.63
SARS-CoV-2 COVID-19 antigen detection, immunoassay, each
$26K
925 claims · 0.0%
$25K
2K claims
$10.43
$40.11
Office/outpatient visit, new patient, low complexity
$25K
2K 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
Similar Providers
Other top providers in Clinic/Center, Community Health