Bay Area Community Health
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $7.7M (2019) to $23.1M (2020) — a 202% swing with $15.5M absolute change.
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:
Billing Swing
Billing Swing means this provider's total billing changed dramatically from one year to the next — increasing or decreasing by more than 200% with over $1M in absolute change. This could indicate a change in practice scope, a billing scheme ramping up, or legitimate growth.
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 $77.54 per claim for 98940 — 5.3× the national median of $14.55.
Bills $83.25 per claim for G0467 (Federally qualified health center visit, mental health) — 3.8× the national median of $21.91.
Bills $31.56 per claim for 90651 (HPV vaccine, 9-valent) — 3.5× the national median of $8.93.
Billing in the top 1% nationally for 1 procedure code: 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 $164.5M is at the 50th percentile among 24 Clinic/Center Federally Qualified Health Center (FQHC) providers.
Total Paid
$164.5M
$164,548,159
Total Claims
1.2M
Beneficiaries
898K
1.3 claims/patient
Avg Cost/Claim
$136
#614 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Bay Area Community Health is a Clinic/Center Federally Qualified Health Center (FQHC) provider based in Fremont, CA. From the 2018–2024 period, this provider received $164.5M in Medicaid payments across 1.2M claims.
Why This Matters
This provider received $164.5M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 20,568 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.
$84.7M
325K claims
$260.61
$121.16
Clinic visit/encounter, all-inclusive
$84.7M
325K claims · 51.5%
Anesthesia services
$74.1M
238K claims · 45.0%
$1.6M
263K claims
$6.20
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$1.6M
263K claims · 1.0%
Psychotherapy, 30 minutes
$597K
28K claims · 0.4%
$539K
59K claims
$9.07
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$539K
59K claims · 0.3%
$375K
4,839 claims · 0.2%
$370K
57K claims
$6.51
$25.06
Office/outpatient visit, low complexity
$370K
57K claims · 0.2%
$317K
2,617 claims
$121.27
$137.85
Other specified case management service, per 15 minutes
$317K
2,617 claims · 0.2%
$261K
8,547 claims
$30.59
$57.85
Office/outpatient visit, new patient, low-mod complexity
$261K
8,547 claims · 0.2%
$230K
23K claims
$10.14
$20.83
Chiropractic manipulative treatment, 3-4 spinal regions
$230K
23K claims · 0.1%
$108K
1,303 claims
$83.25
$21.91
Federally qualified health center visit, mental health
$108K
1,303 claims · 0.1%
$85K
2,957 claims
$28.60
$47.08
Ophthalmological exam, comprehensive, established patient
$85K
2,957 claims · 0.1%
HPV vaccine, 9-valent
$82K
2,595 claims · 0.0%
$59K
1,633 claims
$36.14
$99.21
Psychiatric diagnostic evaluation
$59K
1,633 claims · 0.0%
$54K
1,580 claims
$34.04
$76.06
Preventive medicine, established patient, age 40-64
$54K
1,580 claims · 0.0%
Psychotherapy, 45 minutes
$53K
1,233 claims · 0.0%
$52K
1,345 claims
$38.85
$72.71
Preventive medicine, established patient, age 18-39
$52K
1,345 claims · 0.0%
$50K
2,127 claims
$23.58
$80.15
Preventive medicine, established patient, age 12-17
$50K
2,127 claims · 0.0%
$49K
426 claims
$114.50
$66.78
Coordination of long-term care services, per month
$49K
426 claims · 0.0%
$48K
2,546 claims
$18.91
$74.82
Preventive medicine, established patient, age 5-11
$48K
2,546 claims · 0.0%
Unclassified drugs
$45K
1,320 claims · 0.0%
Tdap vaccine
$43K
3,729 claims · 0.0%
$41K
816 claims · 0.0%
$39K
3,866 claims
$10.15
$74.09
Office/outpatient visit, high complexity
$39K
3,866 claims · 0.0%
$38K
1,508 claims
$24.96
$59.72
Ophthalmological exam, comprehensive, new patient
$38K
1,508 claims · 0.0%
$33K
1,849 claims
$17.86
$9.10
Developmental screening, per standardized instrument
$33K
1,849 claims · 0.0%
$32K
755 claims · 0.0%
$32K
579 claims · 0.0%
$25K
1,651 claims
$15.38
$75.18
Preventive medicine, established patient, age 1-4
$25K
1,651 claims · 0.0%
$24K
5,712 claims
$4.25
$5.50
Hemoglobin A1c (glycated hemoglobin)
$24K
5,712 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
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