Shield California Health Care Center INC
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 57 procedure codes: A4351 at 2.0× median, A4385 at 2.5× 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.
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 $513.91 per claim for B9002 — 9.4× the national median of $54.41.
Billing above the 90th percentile for 6 procedure codes simultaneously.
This is a statistical summary, not an accusation. See our methodology.
Compared to Durable Medical Equipment & Medical Supplies Peers
Total spending distribution among 35 providers in this specialty
This provider's total spending of $522.6M is at the 90th percentile among 35 Durable Medical Equipment & Medical Supplies providers.
Above 90th percentile for this specialty — higher spending than 31 of 35 peers
Total Paid
$522.6M
$522,623,914
Total Claims
10.3M
Beneficiaries
10.1M
1.0 claims/patient
Avg Cost/Claim
$51
#114 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Shield California Health Care Center INC is a Durable Medical Equipment & Medical Supplies provider based in Valencia, CA. From the 2018–2024 period, this provider received $522.6M in Medicaid payments across 10.3M claims.
Why This Matters
This provider received $522.6M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 65,327 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 (T4541 (Pediatric-sized disposable incontinence product, large)) accounts for 18% of total spending.
$93.5M
1.8M claims
$51.91
$41.28
Pediatric-sized disposable incontinence product, large
$93.5M
1.8M claims · 17.9%
$49.4M
1.3M claims
$38.64
$42.03
Adult-sized disposable underpads/pads, large
$49.4M
1.3M claims · 9.5%
$38.6M
603K claims
$63.99
$99.53
Adult-sized disposable incontinence product, large
$38.6M
603K claims · 7.4%
$36.1M
681K claims
$53.08
$88.94
Adult-sized disposable incontinence product, medium
$36.1M
681K claims · 6.9%
$23.6M
361K claims
$65.47
$105.14
Adult-sized disposable incontinence product, extra-large
$23.6M
361K claims · 4.5%
$23.4M
283K claims
$82.66
$96.13
Adult-sized disposable incontinence product, brief/diaper, small
$23.4M
283K claims · 4.5%
$21.1M
155K claims
$135.87
$117.24
Enteral feeding supply kit, pump fed, per day
$21.1M
155K claims · 4.0%
$19.0M
148K claims
$128.34
$110.54
Adult-sized disposable underpads/pads, small
$19.0M
148K claims · 3.6%
$18.5M
81K claims
$228.24
$116.15
Intermittent urinary catheter, straight tip, each
$18.5M
81K claims · 3.5%
$18.4M
264K claims
$69.76
$84.50
Adult-sized disposable incontinence product, brief/diaper, above XL
$18.4M
264K claims · 3.5%
$14.2M
155K claims · 2.7%
$14.0M
175K claims
$80.03
$108.31
Adult-sized disposable incontinence product, brief/diaper, medium
$14.0M
175K claims · 2.7%
$12.0M
194K claims
$62.07
$55.51
Enteral/parenteral nutritional supplies, NOS
$12.0M
194K claims · 2.3%
$10.2M
77K claims · 2.0%
$10.2M
834K claims
$12.25
$9.88
Skin sealant protectant, moisturizer, each ounce
$10.2M
834K claims · 2.0%
Incontinence supply, miscellaneous
$9.2M
866K claims · 1.8%
$6.8M
136K claims · 1.3%
$6.6M
41K claims
$160.71
$157.30
Enteral formula, per 100 calories
$6.6M
41K claims · 1.3%
$6.3M
238K claims · 1.2%
$6.1M
13K claims
$454.11
$465.86
Enteral formula, semisolid, 100 calories = 1 unit
$6.1M
13K claims · 1.2%
Gloves, non-sterile, per 100
$5.5M
364K claims · 1.0%
$5.2M
42K claims · 1.0%
$4.5M
27K claims · 0.9%
$3.8M
7K claims · 0.7%
$3.6M
160K claims · 0.7%
$3.3M
49K claims · 0.6%
$3.2M
379K claims · 0.6%
$2.7M
27K claims · 0.5%
$2.7M
12K claims · 0.5%
$2.4M
28K claims · 0.5%
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 Durable Medical Equipment & Medical Supplies