Seattle-king County Dept of Public Health
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $385.36 per claim for T1015 (Clinic visit/encounter, all-inclusive), which is 3.2× 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.
Compared to Case Manager/Care Coordinator Peers
Total spending distribution among 16 providers in this specialty
This provider's total spending of $74.1M is at the 50th percentile among 16 Case Manager/Care Coordinator providers.
Total Paid
$74.1M
$74,050,493
Total Claims
341K
Beneficiaries
308K
1.1 claims/patient
Avg Cost/Claim
$217
🔍 Analysis
Provider Overview
Seattle-king County Dept of Public Health is a Case Manager/Care Coordinator provider based in Seattle, WA. From the 2018–2024 period, this provider received $74.1M in Medicaid payments across 341K 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
At $74.1M in Medicaid payments, this provider represents significant public healthcare spending. Understanding where these dollars go helps ensure the program serves those who need it most.
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