Lake County Tribal Health Consortium Inc.
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $590.98 per claim for T1015 (Clinic visit/encounter, all-inclusive), which is 4.9× the national median of $121.16.
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.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Bills $590.98 per claim for T1015 (Clinic visit/encounter, all-inclusive) — 4.9× the national median of $121.16.
Bills $417.38 per claim for G0467 (Federally qualified health center visit, mental health) — 19.1× the national median of $21.91.
Bills $444.01 per claim for 98940 — 30.5× the national median of $14.55.
Billing in the top 1% nationally for 6 procedure codes: T1015, G0467, 98940.
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 $140.6M is at the 50th percentile among 24 Clinic/Center Federally Qualified Health Center (FQHC) providers.
Total Paid
$140.6M
$140,627,797
Total Claims
375K
Beneficiaries
257K
1.5 claims/patient
Avg Cost/Claim
$375
#787 of 618K providers by total spending(top 0.1%)
🔍 Analysis
Provider Overview
Lake County Tribal Health Consortium Inc. is a Clinic/Center Federally Qualified Health Center (FQHC) provider based in Lakeport, CA. From the 2018–2024 period, this provider received $140.6M in Medicaid payments across 375K 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 $140.6M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 17,578 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 51% of total spending.
$71.2M
120K claims
$590.98
$121.16
Clinic visit/encounter, all-inclusive
$71.2M
120K claims · 50.6%
Anesthesia services
$46.1M
78K claims · 32.8%
$13.7M
33K claims
$417.38
$21.91
Federally qualified health center visit, mental health
$13.7M
33K claims · 9.8%
$5.3M
12K claims · 3.8%
$2.7M
4K claims · 1.9%
$1.2M
3K claims
$375.18
$45.95
Chronic care management services, FQHC/RHC
$1.2M
3K claims · 0.8%
$240K
491 claims · 0.2%
$75K
1K claims
$66.00
$24.33
Medical nutrition therapy, reassessment, group, thirty minutes
$75K
1K claims · 0.1%
$47K
1K claims · 0.0%
$27K
204 claims
$132.28
$12.70
Medical nutrition therapy, reassessment, individual, fifteen minutes
$27K
204 claims · 0.0%
$26K
36 claims · 0.0%
$6K
226 claims · 0.0%
$4K
115 claims
$32.83
$32.49
COVID-19 vaccine admin, J&J, single dose
$4K
115 claims · 0.0%
$3K
147 claims
$21.27
$25.93
COVID-19 vaccine admin, Moderna, 1st dose
$3K
147 claims · 0.0%
$2K
28 claims · 0.0%
$960
24 claims
$40.00
$33.85
COVID-19 vaccine admin, Moderna, 2nd dose
$960
24 claims · 0.0%
$880
22 claims
$40.00
$33.72
COVID-19 vaccine admin, Pfizer, 1st dose
$880
22 claims · 0.0%
$680
17 claims
$40.00
$36.70
COVID-19 vaccine admin, Pfizer, 2nd dose
$680
17 claims · 0.0%
$609
9K claims
$0.07
$25.06
Office/outpatient visit, low complexity
$609
9K claims · 0.0%
$570
15 claims · 0.0%
$296
37K claims
$0.01
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$296
37K claims · 0.0%
$223
3K claims · 0.0%
$22
5K claims
$0.00
$16.79
Manual therapy techniques, per 15 minutes
$22
5K claims · 0.0%
$12
8K claims
$0.00
$20.04
Therapeutic procedure, neuromuscular reeducation, per 15 minutes
$12
8K claims · 0.0%
Therapeutic exercises, each 15 min
$11
8K claims · 0.0%
$0
43 claims · 0.0%
PT evaluation, moderate complexity
$0
318 claims · 0.0%
$0
135 claims
$0.00
$81.92
Preventive visit, new patient, late childhood (5-11 yr)
$0
135 claims · 0.0%
Gait training
$0
45 claims · 0.0%
$0
509 claims
$0.00
$1.57
Collection of venous blood by venipuncture
$0
509 claims · 0.0%
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