City & County of San Francisco
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $641.21 per claim for H2010 (Comprehensive medication services, per 15 min), which is 10.2× the national median of $62.69.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 35 procedure codes: H2015 at 5.2× median, S9484 at 13.1× median.
Unusually High Spending
This provider's total payments are significantly above the median for their specialty.
High Cost Per Claim
Average payment per claim is much higher than peers billing the same procedures.
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.
Unusually High Spending
Unusually High Spending means this provider's total Medicaid payments are significantly above the median for their specialty. This doesn't necessarily indicate fraud — high volume practices and those serving complex populations may legitimately bill more.
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.
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 $498.36 per claim for H2015 (Comprehensive community support services, per 15 min) — 5.2× the national median of $96.24.
Bills $3,278.39 per claim for S9484 (Crisis intervention mental health services, per hour) — 13.1× the national median of $249.51.
Bills $343.97 per claim for H0034 (Medication training and management, per 15 min) — 6.0× the national median of $56.90.
Billing in the top 1% nationally for 8 procedure codes: 90837, 90834, H2019.
This is a statistical summary, not an accusation. See our methodology.
Compared to Community/Behavioral Health Peers
Total spending distribution among 218 providers in this specialty
This provider's total spending of $1.34B is at the 90th percentile among 218 Community/Behavioral Health providers.
Above 90th percentile for this specialty — higher spending than 196 of 218 peers
Total Paid
$1.34B
$1,344,222,550
Total Claims
6.2M
Beneficiaries
1.3M
4.7 claims/patient
Avg Cost/Claim
$217
#18 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
City & County of San Francisco is a Community/Behavioral Health provider based in San Francisco, CA. From the 2018–2024 period, this provider received $1.3B in Medicaid payments across 6.2M 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 $1.3B in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 168,027 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 (H2015 (Comprehensive community support services, per 15 min)) accounts for 28% of total spending.
$369.7M
742K claims
$498.36
$96.24
Comprehensive community support services, per 15 min
$369.7M
742K claims · 27.5%
$145.1M
44K claims
$3,278.39
$249.51
Crisis intervention mental health services, per hour
$145.1M
44K claims · 10.8%
$141.7M
412K claims
$343.97
$56.90
Medication training and management, per 15 min
$141.7M
412K claims · 10.5%
$133.9M
436K claims
$306.98
$69.56
Targeted case management, per 15 min
$133.9M
436K claims · 10.0%
$120.1M
316K claims
$379.69
$91.63
Psychosocial rehabilitation services, per 15 min
$120.1M
316K claims · 8.9%
$111.0M
173K claims
$641.21
$62.69
Comprehensive medication services, per 15 min
$111.0M
173K claims · 8.3%
$74.6M
281K claims
$265.04
$357.16
Behavioral health; residential, per diem
$74.6M
281K claims · 5.5%
$45.2M
3.1M claims
$14.82
$18.95
Alcohol/drug services; methadone administration
$45.2M
3.1M claims · 3.4%
$32.7M
67K claims
$487.79
$467.51
Behavioral health; short-term residential, per diem
$32.7M
67K claims · 2.4%
$29.2M
78K claims
$375.22
$80.64
Mental health service plan development
$29.2M
78K claims · 2.2%
Psychotherapy, 60 minutes
$26.5M
57K claims · 2.0%
$24.5M
239K claims
$102.68
$74.63
Behavioral health counseling & therapy, per 15 min
$24.5M
239K claims · 1.8%
$16.2M
11K claims
$1,532.55
$215.80
Crisis intervention service, per 15 minutes
$16.2M
11K claims · 1.2%
Psychotherapy, 45 minutes
$12.0M
32K claims · 0.9%
$9.7M
10K claims
$940.27
$84.12
Therapeutic behavioral services, per 15 min
$9.7M
10K claims · 0.7%
$9.2M
17K claims · 0.7%
$6.9M
18K claims
$381.67
$72.96
Prolonged office/outpatient E/M, each additional 15 min
$6.9M
18K claims · 0.5%
$6.8M
7K claims
$1,028.56
$74.09
Office/outpatient visit, high complexity
$6.8M
7K claims · 0.5%
$5.3M
7K claims
$799.92
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$5.3M
7K claims · 0.4%
$5.0M
9K claims
$570.07
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$5.0M
9K claims · 0.4%
$3.5M
66K claims
$53.46
$47.35
Alcohol and/or drug services, group counseling
$3.5M
66K claims · 0.3%
Psychotherapy, 30 minutes
$2.1M
10K claims · 0.2%
Telephone E/M by physician, 21-30 min
$2.0M
4K claims · 0.1%
$1.7M
5K claims
$335.75
$25.06
Office/outpatient visit, low complexity
$1.7M
5K claims · 0.1%
Psychiatric diagnostic evaluation
$1.4M
9K claims · 0.1%
Prescription drug, generic
$1.1M
42K claims · 0.1%
$990K
5K claims
$211.54
$137.86
Behavioral health day treatment, per hour
$990K
5K claims · 0.1%
$782K
8K claims
$98.16
$43.10
Alcohol and/or drug services, case management
$782K
8K claims · 0.1%
Day habilitation, waiver; per 15 min
$622K
1K claims · 0.0%
$581K
2K claims
$358.83
$96.18
Mental health assessment by non-physician
$581K
2K 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
Los Angeles County Department of Public Health
Public Health or Welfare
$1.13B
Alameda County Behavioral Health Care
Community/Behavioral Health
$1.07B
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