Swinomish Health Services
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $459.39 per claim for T1015 (Clinic visit/encounter, all-inclusive), which is 3.8× the national median of $121.16.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 3 procedure codes: T1015 at 3.8× median, 90661 at 2.6× median.
High Cost Per Claim
Average payment per claim is much higher than peers billing the same procedures.
High Claims Per Patient
Filing an unusually high number of claims per beneficiary compared to peers.
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.
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.
High Claims Per Patient
High Claims Per Patient means this provider files an unusually high number of claims per individual patient. This could indicate legitimate intensive treatment or a pattern of billing for services not actually rendered.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Bills $459.39 per claim for T1015 (Clinic visit/encounter, all-inclusive) — 3.8× the national median of $121.16.
Bills $33.13 per claim for 96153 (Health/behavior intervention, group) — 5.0× the national median of $6.67.
This is a statistical summary, not an accusation. See our methodology.
Compared to Clinic/Center Rehabilitation Substance Use Disorder Peers
Total spending distribution among 8 providers in this specialty
This provider's total spending of $195.9M is at the 50th percentile among 8 Clinic/Center Rehabilitation Substance Use Disorder providers.
Total Paid
$195.9M
$195,928,569
Total Claims
832K
Beneficiaries
122K
6.8 claims/patient
Avg Cost/Claim
$235
#471 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Swinomish Health Services is a Clinic/Center Rehabilitation Substance Use Disorder provider based in Anacortes, WA. From the 2018–2024 period, this provider received $195.9M in Medicaid payments across 832K claims.
Why This Matters
This provider received $195.9M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 24,491 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 95% of total spending.
$186.6M
406K claims
$459.39
$121.16
Clinic visit/encounter, all-inclusive
$186.6M
406K claims · 95.3%
$4.9M
298K claims
$16.45
$18.95
Alcohol/drug services; methadone administration
$4.9M
298K claims · 2.5%
$1.6M
24K claims
$64.57
$74.63
Behavioral health counseling & therapy, per 15 min
$1.6M
24K claims · 0.8%
Health/behavior intervention, group
$529K
16K claims · 0.3%
$445K
20K claims
$21.83
$15.54
Health behavior intervention, family, each additional fifteen minutes
$445K
20K claims · 0.2%
$388K
21K claims · 0.2%
$317K
11K claims
$28.78
$25.06
Office/outpatient visit, low complexity
$317K
11K claims · 0.2%
Psychotherapy, 60 minutes
$265K
4K claims · 0.1%
Alcohol and/or drug assessment
$228K
2K claims · 0.1%
$192K
5K claims
$37.80
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$192K
5K claims · 0.1%
$119K
2K claims
$55.04
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$119K
2K claims · 0.1%
$118K
9K claims
$12.53
$31.37
Oral medication administration, direct observation
$118K
9K claims · 0.1%
Psychotherapy, 30 minutes
$66K
1K claims · 0.0%
$58K
5K claims
$11.29
$12.93
Office/outpatient visit, minimal complexity
$58K
5K claims · 0.0%
$13K
2K claims
$8.17
$9.70
Electrocardiogram, complete, with interpretation and report
$13K
2K claims · 0.0%
$11K
136 claims
$79.14
$74.09
Office/outpatient visit, high complexity
$11K
136 claims · 0.0%
$10K
206 claims
$50.11
$55.04
Self-help/peer services, per 15 minutes
$10K
206 claims · 0.0%
$10K
276 claims
$35.10
$27.07
Limited oral evaluation, problem focused
$10K
276 claims · 0.0%
$9K
485 claims
$18.58
$73.29
Medication-assisted treatment, opioid use disorder, per month
$9K
485 claims · 0.0%
$8K
139 claims
$54.84
$57.39
Extraction, erupted tooth or exposed root
$8K
139 claims · 0.0%
Collection of venous blood by venipuncture
$6K
2K claims · 0.0%
$5K
128 claims
$37.38
$32.07
Comprehensive oral evaluation, new or established patient
$5K
128 claims · 0.0%
$4K
52 claims
$77.54
$84.03
Office/outpatient visit, new patient, mod-high complexity
$4K
52 claims · 0.0%
Psychiatric diagnostic evaluation
$4K
42 claims · 0.0%
Psychotherapy, 45 minutes
$3K
51 claims · 0.0%
Panoramic radiographic image
$3K
110 claims · 0.0%
$3K
261 claims · 0.0%
$3K
47 claims
$64.91
$57.85
Office/outpatient visit, new patient, low-mod complexity
$3K
47 claims · 0.0%
COVID-19 vaccine admin, J&J, single dose
$2K
60 claims · 0.0%
$2K
105 claims
$21.92
$33.85
COVID-19 vaccine admin, Moderna, 2nd dose
$2K
105 claims · 0.0%
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