Statistical flags indicate unusual patterns — not proof of fraud or wrongdoing. Read our methodology

County of San Diego

Public Health or Welfare·San Diego, CA·NPI: 1225255375SharePrint Report
View on Risk Watchlist →

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:

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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.

Risk Assessment

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Bills $1,148.47 per claim for 99233 (Subsequent hospital care, per day, high complexity) — 32.5× the national median of $35.30.

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Bills $929.12 per claim for 99232 (Subsequent hospital care, per day, moderate complexity) — 38.7× the national median of $23.99.

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Bills $531.10 per claim for 99214 (Office/outpatient visit, est. patient, mod-high complexity) — 9.9× the national median of $53.41.

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Billing in the top 1% nationally for 11 procedure codes: 99233, 99232, 99214.

This is a statistical summary, not an accusation. See our methodology.

Compared to Public Health or Welfare Peers

Total spending distribution among 17 providers in this specialty

P25MedianP75P90

This provider's total spending of $642.5M is at the 75th percentile among 17 Public Health or Welfare providers.

Active Billing Period:2018-01→2024-10(82 months)

Total Paid

$642.5M

$642,451,488

Total Claims

5.5M

Beneficiaries

1.1M

5.0 claims/patient

Avg Cost/Claim

$118

#79 of 618K providers by total spending(top <0.1%)

🔍 Analysis

Provider Overview

County of San Diego is a Public Health or Welfare provider based in San Diego, CA. From the 2018–2024 period, this provider received $642.5M in Medicaid payments across 5.5M 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 $642.5M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 80,306 Medicaid beneficiaries for a full year at average per-enrollee costs.

↑ 268% growthsince first billing year

Monthly Spending Trend

Yearly Spending

2018
$30.1M
+93%
2019
$58.1M
+42%
2020
$82.5M
+20%
2021
$99.0M
+5%
2022
$103.9M
+52%
2023
$158.5M
-30%
2024
$110.4M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 30 distinct procedure codes. The top code (H0019 (Behavioral health; residential, per diem)) accounts for 33% of total spending.

H0019Normal range

Behavioral health; residential, per diem

$211.0M

1.1M claims · 32.8%

Your Cost: $196.68/claim|Median: $357.16
0.6× median
H0004Top 10%

Behavioral health counseling & therapy, per 15 min

$90.9M

609K claims · 14.1%

Your Cost: $149.12/claim|Median: $74.63
2.0× median
H0020Normal range

Alcohol/drug services; methadone administration

$67.9M

1.4M claims · 10.6%

Your Cost: $49.87/claim|Median: $18.95
2.6× median
H0005Top 10%

Alcohol and/or drug services, group counseling

$59.9M

707K claims · 9.3%

Your Cost: $84.71/claim|Median: $47.35
1.8× median
H2015Normal range

Comprehensive community support services, per 15 min

$45.7M

457K claims · 7.1%

Your Cost: $100.00/claim|Median: $96.24
1.0× median
H0006Top 10%

Alcohol and/or drug services, case management

$24.3M

203K claims · 3.8%

Your Cost: $119.58/claim|Median: $43.10
2.8× median
99233Top 1%

Subsequent hospital care, per day, high complexity

$16.9M

15K claims · 2.6%

Your Cost: $1,148.47/claim|Median: $35.30
32.5× median
99232Top 1%

Subsequent hospital care, per day, moderate complexity

$16.1M

17K claims · 2.5%

Your Cost: $929.12/claim|Median: $23.99
38.7× median
H0012Normal range

$14.5M

51K claims · 2.3%

Your Cost: $283.15/claim|Median: $295.95
1.0× median
H2010Normal range

Comprehensive medication services, per 15 min

$12.5M

129K claims · 2.0%

Your Cost: $97.00/claim|Median: $62.69
1.6× median
99214Top 1%

Office/outpatient visit, est. patient, mod-high complexity

$9.4M

18K claims · 1.5%

Your Cost: $531.10/claim|Median: $53.41
9.9× median
T1017Top 25%

Targeted case management, per 15 min

$7.8M

45K claims · 1.2%

Your Cost: $175.76/claim|Median: $69.56
2.5× median
90837Top 1%

Psychotherapy, 60 minutes

$6.0M

15K claims · 0.9%

Your Cost: $406.40/claim|Median: $85.66
4.7× median
90833Top 1%

Psychotherapy, 30 min, add-on to E/M service

$5.8M

11K claims · 0.9%

Your Cost: $553.26/claim|Median: $38.83
14.3× median
S5000Normal range

Prescription drug, generic

$5.7M

462K claims · 0.9%

Your Cost: $12.29/claim|Median: $7.47
1.6× median
99213Top 1%

Office/outpatient visit, est. patient, low-mod complexity

$4.9M

9K claims · 0.8%

Your Cost: $520.47/claim|Median: $37.81
13.8× median
G2212Top 10%

Prolonged office/outpatient E/M, each additional 15 min

$4.7M

8K claims · 0.7%

Your Cost: $577.22/claim|Median: $72.96
7.9× median
H0015Normal range

Alcohol and/or drug abuse, intensive outpatient, per hour

$4.4M

58K claims · 0.7%

Your Cost: $75.28/claim|Median: $129.75
0.6× median
0160Top 5%

$4.3M

339 claims · 0.7%

Your Cost: $12,688.71/claim|Median: $54.01
234.9× median
99223Top 1%

Initial hospital care, per day, high complexity

$3.4M

2K claims · 0.5%

Your Cost: $1,767.70/claim|Median: $67.32
26.3× median
S5001Normal range

$3.2M

91K claims · 0.5%

Your Cost: $35.56/claim|Median: $17.91
2.0× median
99215Top 1%

Office/outpatient visit, high complexity

$2.3M

2K claims · 0.4%

Your Cost: $987.68/claim|Median: $74.09
13.3× median
99239Top 1%

Hospital discharge day management, more than 30 minutes

$2.3M

2K claims · 0.4%

Your Cost: $1,228.37/claim|Median: $43.85
28.0× median
H2011Normal range

Crisis intervention service, per 15 minutes

$2.2M

9K claims · 0.3%

Your Cost: $249.89/claim|Median: $215.80
1.2× median
90834Top 1%

Psychotherapy, 45 minutes

$1.7M

5K claims · 0.3%

Your Cost: $323.00/claim|Median: $63.65
5.1× median
H2014Normal range

Skills training & development, per 15 min

$1.7M

16K claims · 0.3%

Your Cost: $103.38/claim|Median: $83.88
1.2× median
G0397Top 25%

$1.6M

5K claims · 0.2%

Your Cost: $306.50/claim|Median: $142.31
2.1× median
90792Top 10%

Psychiatric diagnostic evaluation with medical services

$1.3M

5K claims · 0.2%

Your Cost: $276.82/claim|Median: $108.91
2.5× median
99255Top 1%

$1.2M

607 claims · 0.2%

Your Cost: $1,985.70/claim|Median: $90.45
21.9× median
H2017Top 25%

Psychosocial rehabilitation services, per 15 min

$1.1M

8K claims · 0.2%

Your Cost: $135.43/claim|Median: $91.63
1.5× median

Other Top Providers in California

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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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