County of Riverside
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $516.76 per claim for 90837 (Psychotherapy, 60 minutes), which is 6.0× the national median of $85.66.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 28 procedure codes: H0034 at 4.6× median, 90837 at 6.0× 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 $260.53 per claim for H0034 (Medication training and management, per 15 min) — 4.6× the national median of $56.90.
Bills $799.88 per claim for S9484 (Crisis intervention mental health services, per hour) — 3.2× the national median of $249.51.
Bills $516.76 per claim for 90837 (Psychotherapy, 60 minutes) — 6.0× the national median of $85.66.
Billing in the top 1% nationally for 9 procedure codes: 90837, 90834, 99232.
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 $1.40B 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
$1.40B
$1,398,902,370
Total Claims
8.7M
Beneficiaries
2.3M
3.7 claims/patient
Avg Cost/Claim
$161
#16 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
County of Riverside is a Community/Behavioral Health provider based in Riverside, CA. From the 2018–2024 period, this provider received $1.4B in Medicaid payments across 8.7M 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 $1.4B in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 174,862 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 (H0034 (Medication training and management, per 15 min)) accounts for 16% of total spending.
$225.5M
865K claims
$260.53
$56.90
Medication training and management, per 15 min
$225.5M
865K claims · 16.1%
$220.9M
1.3M claims
$167.98
$96.24
Comprehensive community support services, per 15 min
$220.9M
1.3M claims · 15.8%
$179.1M
772K claims
$231.89
$357.16
Behavioral health; residential, per diem
$179.1M
772K claims · 12.8%
$160.9M
1.1M claims
$147.22
$91.63
Psychosocial rehabilitation services, per 15 min
$160.9M
1.1M claims · 11.5%
$144.7M
866K claims
$167.17
$69.56
Targeted case management, per 15 min
$144.7M
866K claims · 10.3%
$78.2M
98K claims
$799.88
$249.51
Crisis intervention mental health services, per hour
$78.2M
98K claims · 5.6%
Psychotherapy, 60 minutes
$64.7M
125K claims · 4.6%
$36.6M
2.4M claims
$15.22
$18.95
Alcohol/drug services; methadone administration
$36.6M
2.4M claims · 2.6%
$33.3M
79K claims
$421.08
$84.12
Therapeutic behavioral services, per 15 min
$33.3M
79K claims · 2.4%
$30.5M
96K claims
$319.21
$55.04
Self-help/peer services, per 15 minutes
$30.5M
96K claims · 2.2%
$28.4M
203K claims
$139.42
$74.63
Behavioral health counseling & therapy, per 15 min
$28.4M
203K claims · 2.0%
$27.3M
76K claims
$358.46
$467.51
Behavioral health; short-term residential, per diem
$27.3M
76K claims · 2.0%
$20.9M
63K claims
$331.28
$62.69
Comprehensive medication services, per 15 min
$20.9M
63K claims · 1.5%
Psychotherapy, 45 minutes
$19.6M
59K claims · 1.4%
$18.9M
56K claims
$336.75
$215.80
Crisis intervention service, per 15 minutes
$18.9M
56K claims · 1.3%
$17.4M
17K claims
$1,005.60
$841.93
Psychiatric health facility service, per diem
$17.4M
17K claims · 1.2%
$12.5M
179K claims
$69.65
$47.35
Alcohol and/or drug services, group counseling
$12.5M
179K claims · 0.9%
$12.3M
33K claims
$374.08
$72.96
Prolonged office/outpatient E/M, each additional 15 min
$12.3M
33K claims · 0.9%
$8.8M
36K claims · 0.6%
$7.7M
9K claims
$832.32
$23.99
Subsequent hospital care, per day, moderate complexity
$7.7M
9K claims · 0.6%
$7.3M
17K claims
$418.18
$77.33
Family psychotherapy with patient, 50 min
$7.3M
17K claims · 0.5%
$7.3M
63K claims
$115.77
$36.25
Behavioral health prevention education, per session
$7.3M
63K claims · 0.5%
$5.1M
9K claims
$601.75
$16.77
Subsequent hospital care, per day, low complexity
$5.1M
9K claims · 0.4%
Psychotherapy, 30 minutes
$4.3M
19K claims · 0.3%
$4.3M
3K claims
$1,641.77
$111.09
Office/outpatient visit, new patient, high complexity
$4.3M
3K claims · 0.3%
$2.4M
2K claims
$1,133.56
$43.85
Hospital discharge day management, more than 30 minutes
$2.4M
2K claims · 0.2%
Psychiatric diagnostic evaluation
$2.3M
15K claims · 0.2%
Prescription drug, generic
$2.3M
73K claims · 0.2%
$2.1M
1K claims
$1,395.15
$51.25
Initial hospital care, per day, moderate complexity
$2.1M
1K claims · 0.1%
$1.8M
13K claims
$142.84
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$1.8M
13K claims · 0.1%
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