Northern Valley Indian Health INC
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $543.37 per claim for T1015 (Clinic visit/encounter, all-inclusive), which is 4.5× the national median of $121.16.
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $10.3M (2018) to $38.4M (2019) — a 272% swing with $28.1M absolute change.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 11 procedure codes: 00003 at 2.4× median, T1015 at 4.5× 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
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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.
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.
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
Bills $543.37 per claim for T1015 (Clinic visit/encounter, all-inclusive) — 4.5× the national median of $121.16.
Bills $252.63 per claim for G0467 (Federally qualified health center visit, mental health) — 11.5× the national median of $21.91.
Bills $197.94 per claim for 59425 (Antepartum care only, 4-6 visits) — 3.1× the national median of $63.63.
Billing above the 90th percentile for 7 procedure codes simultaneously.
This is a statistical summary, not an accusation. See our methodology.
Compared to Clinic/Center Peers
Total spending distribution among 13 providers in this specialty
This provider's total spending of $217.1M is at the 75th percentile among 13 Clinic/Center providers.
Total Paid
$217.1M
$217,070,731
Total Claims
850K
Beneficiaries
687K
1.2 claims/patient
Avg Cost/Claim
$255
#397 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Northern Valley Indian Health INC is a Clinic/Center provider based in Willows, CA. From the 2018–2024 period, this provider received $217.1M in Medicaid payments across 850K claims.
Why This Matters
This provider received $217.1M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 27,133 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 (00003 (Anesthesia services)) accounts for 53% of total spending.
Anesthesia services
$115.9M
220K claims · 53.4%
$88.5M
163K claims
$543.37
$121.16
Clinic visit/encounter, all-inclusive
$88.5M
163K claims · 40.8%
$3.8M
15K claims
$252.63
$21.91
Federally qualified health center visit, mental health
$3.8M
15K claims · 1.8%
$2.5M
58K claims
$43.54
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$2.5M
58K claims · 1.2%
$1.1M
33K claims
$34.17
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$1.1M
33K claims · 0.5%
$581K
4,862 claims · 0.3%
$481K
12K claims
$41.33
$75.18
Preventive medicine, established patient, age 1-4
$481K
12K claims · 0.2%
$474K
11K claims
$42.70
$69.35
Preventive medicine, established patient, infant (under 1)
$474K
11K claims · 0.2%
Psychotherapy, 60 minutes
$461K
7,102 claims · 0.2%
Antepartum care only, 4-6 visits
$446K
2,251 claims · 0.2%
$443K
9,016 claims
$49.18
$9.10
Developmental screening, per standardized instrument
$443K
9,016 claims · 0.2%
$406K
8,837 claims
$45.94
$25.06
Office/outpatient visit, low complexity
$406K
8,837 claims · 0.2%
Psychotherapy, 45 minutes
$383K
8,330 claims · 0.2%
$214K
1,632 claims
$131.14
$45.95
Chronic care management services, FQHC/RHC
$214K
1,632 claims · 0.1%
Psychotherapy, 30 minutes
$168K
5,255 claims · 0.1%
$157K
4,979 claims
$31.57
$74.82
Preventive medicine, established patient, age 5-11
$157K
4,979 claims · 0.1%
$123K
13K claims · 0.1%
$74K
9,041 claims · 0.0%
$63K
11K claims · 0.0%
$60K
2,415 claims
$24.95
$80.15
Preventive medicine, established patient, age 12-17
$60K
2,415 claims · 0.0%
$55K
8,622 claims · 0.0%
$47K
12K claims
$3.95
$7.18
Influenza virus vaccine, quadrivalent, preservative-free, IM
$47K
12K claims · 0.0%
$46K
1,002 claims
$45.65
$99.21
Psychiatric diagnostic evaluation
$46K
1,002 claims · 0.0%
$41K
1,122 claims
$36.83
$36.70
COVID-19 vaccine admin, Pfizer, 2nd dose
$41K
1,122 claims · 0.0%
DTaP-HepB-IPV vaccine
$36K
6,852 claims · 0.0%
$33K
1,049 claims
$31.10
$33.72
COVID-19 vaccine admin, Pfizer, 1st dose
$33K
1,049 claims · 0.0%
$29K
1,420 claims
$20.20
$73.46
Preventive visit, new patient, infant (<1 yr)
$29K
1,420 claims · 0.0%
$27K
796 claims · 0.0%
$22K
113 claims
$192.56
$79.89
Preventive visit, new patient, early childhood (1-4 yr)
$22K
113 claims · 0.0%
MMRV vaccine
$21K
3,837 claims · 0.0%
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