County of Santa Clara
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $410.60 per claim for T1015 (Clinic visit/encounter, all-inclusive), which is 3.4× 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.
Risk Assessment
Bills $410.60 per claim for T1015 (Clinic visit/encounter, all-inclusive) — 3.4× the national median of $121.16.
Bills $110.13 per claim for G0467 (Federally qualified health center visit, mental health) — 5.0× the national median of $21.91.
Bills $219.56 per claim for G9008 (Coordination of long-term care services, per month) — 3.3× the national median of $66.78.
Billing above the 90th percentile for 3 procedure codes simultaneously.
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 $127.9M is at the 50th percentile among 24 Clinic/Center Federally Qualified Health Center (FQHC) providers.
Total Paid
$127.9M
$127,878,847
Total Claims
1.2M
Beneficiaries
942K
1.3 claims/patient
Avg Cost/Claim
$106
#918 of 618K providers by total spending(top 0.1%)
🔍 Analysis
Provider Overview
County of Santa Clara is a Clinic/Center Federally Qualified Health Center (FQHC) provider based in San Jose, CA. From the 2018–2024 period, this provider received $127.9M in Medicaid payments across 1.2M 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 $127.9M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 15,984 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 71% of total spending.
$90.8M
221K claims
$410.60
$121.16
Clinic visit/encounter, all-inclusive
$90.8M
221K claims · 71.0%
Anesthesia services
$33.8M
65K claims · 26.4%
$1.1M
10K claims
$110.13
$21.91
Federally qualified health center visit, mental health
$1.1M
10K claims · 0.8%
$517K
4K claims
$146.08
$137.85
Other specified case management service, per 15 minutes
$517K
4K claims · 0.4%
$328K
152K claims
$2.15
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$328K
152K claims · 0.3%
$283K
1K claims
$219.56
$66.78
Coordination of long-term care services, per month
$283K
1K claims · 0.2%
$183K
53K claims
$3.49
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$183K
53K claims · 0.1%
$87K
21K claims
$4.05
$75.18
Preventive medicine, established patient, age 1-4
$87K
21K claims · 0.1%
$66K
16K claims
$4.22
$69.35
Preventive medicine, established patient, infant (under 1)
$66K
16K claims · 0.1%
$64K
44K claims
$1.46
$25.06
Office/outpatient visit, low complexity
$64K
44K claims · 0.1%
$56K
14K claims
$3.98
$74.82
Preventive medicine, established patient, age 5-11
$56K
14K claims · 0.0%
HPV vaccine, 9-valent
$50K
6K claims · 0.0%
$42K
2K claims
$19.91
$25.93
COVID-19 vaccine admin, Moderna, 1st dose
$42K
2K claims · 0.0%
$41K
8K claims · 0.0%
$37K
321 claims · 0.0%
$31K
1K claims · 0.0%
$27K
4K claims
$6.95
$24.95
Chlamydia detection, nucleic acid, amplified probe
$27K
4K claims · 0.0%
$27K
4K claims
$6.94
$23.39
Neisseria gonorrhoeae detection, nucleic acid, amplified probe
$27K
4K claims · 0.0%
$27K
7K claims
$4.08
$80.15
Preventive medicine, established patient, age 12-17
$27K
7K claims · 0.0%
$23K
22K claims
$1.06
$6.61
Screening audiometry, pure tone, air only
$23K
22K claims · 0.0%
$23K
4K claims · 0.0%
$22K
25K claims
$0.88
$7.18
Influenza virus vaccine, quadrivalent, preservative-free, IM
$22K
25K claims · 0.0%
Lipid panel
$19K
13K claims · 0.0%
$18K
20K claims
$0.93
$5.50
Hemoglobin A1c (glycated hemoglobin)
$18K
20K claims · 0.0%
$18K
2K claims · 0.0%
Thyroid stimulating hormone (TSH)
$17K
12K claims · 0.0%
$17K
1K claims · 0.0%
Tdap vaccine
$16K
5K claims · 0.0%
$15K
2K claims
$7.77
$74.09
Office/outpatient visit, high complexity
$15K
2K claims · 0.0%
$15K
7K claims · 0.0%
Other Top Providers in California
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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
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$1.34B
Los Angeles County Department of Public Health
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$1.13B
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