El Rio Santa Cruz Neighborhood Health Center, INC
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 3 procedure codes: T1015 at 2.4× median, 59514 at 2.1× 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:
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
Billing above the 90th percentile for 2 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 16 providers in this specialty
This provider's total spending of $360.3M is at the 99th percentile among 16 Clinic/Center, Federally Qualified Health Center (FQHC) providers.
Above 99th percentile for this specialty — higher spending than 15 of 16 peers
Total Paid
$360.3M
$360,316,533
Total Claims
4.4M
Beneficiaries
3.6M
1.2 claims/patient
Avg Cost/Claim
$83
#188 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
El Rio Santa Cruz Neighborhood Health Center, INC is a Clinic/Center, Federally Qualified Health Center (FQHC) provider based in Tucson, AZ. From the 2018–2024 period, this provider received $360.3M in Medicaid payments across 4.4M claims.
Why This Matters
This provider received $360.3M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 45,039 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 99% of total spending.
$357.8M
1.2M claims
$288.24
$121.16
Clinic visit/encounter, all-inclusive
$357.8M
1.2M claims · 99.3%
$472K
399K claims
$1.18
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$472K
399K claims · 0.1%
$336K
5,622 claims
$59.77
$37.22
Hospital discharge day management, 30 minutes or less
$336K
5,622 claims · 0.1%
Vaginal delivery only
$240K
288 claims · 0.1%
$222K
406K claims
$0.55
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$222K
406K claims · 0.1%
$214K
3,303 claims
$64.65
$62.48
Initial hospital or birthing center care, newborn, per day
$214K
3,303 claims · 0.1%
Case management, each 15 min
$194K
17K claims · 0.1%
$192K
3,403 claims
$56.43
$35.30
Subsequent hospital care, per day, high complexity
$192K
3,403 claims · 0.1%
$130K
3,999 claims
$32.44
$16.77
Subsequent hospital care, per day, low complexity
$130K
3,999 claims · 0.0%
$103K
2,644 claims
$38.94
$23.99
Subsequent hospital care, per day, moderate complexity
$103K
2,644 claims · 0.0%
$38K
750 claims
$51.26
$43.85
Hospital discharge day management, more than 30 minutes
$38K
750 claims · 0.0%
Cesarean delivery only
$24K
26 claims · 0.0%
$23K
124K claims
$0.18
$9.80
Immunization administration, 1 vaccine, percutaneous/ID/SC/IM
$23K
124K claims · 0.0%
$21K
5,310 claims
$4.04
$84.03
Office/outpatient visit, new patient, mod-high complexity
$21K
5,310 claims · 0.0%
$21K
6,058 claims
$3.42
$96.18
Mental health assessment by non-physician
$21K
6,058 claims · 0.0%
Psychotherapy, 60 minutes
$20K
14K claims · 0.0%
$19K
7,338 claims · 0.0%
$14K
11K claims
$1.37
$74.09
Office/outpatient visit, high complexity
$14K
11K claims · 0.0%
$14K
3,670 claims
$3.90
$108.91
Psychiatric diagnostic evaluation with medical services
$14K
3,670 claims · 0.0%
$14K
41K claims
$0.34
$69.35
Preventive medicine, established patient, infant (under 1)
$14K
41K claims · 0.0%
$12K
17K claims · 0.0%
Psychotherapy, 45 minutes
$10K
10K claims · 0.0%
$10K
20K claims
$0.48
$72.71
Preventive medicine, established patient, age 18-39
$10K
20K claims · 0.0%
$9K
18K claims
$0.50
$76.06
Preventive medicine, established patient, age 40-64
$9K
18K claims · 0.0%
$9K
31K claims
$0.29
$75.18
Preventive medicine, established patient, age 1-4
$9K
31K claims · 0.0%
$8K
11K claims
$0.73
$74.63
Behavioral health counseling & therapy, per 15 min
$8K
11K claims · 0.0%
$8K
2,845 claims
$2.81
$76.22
Preventive visit, new patient, 18-39 yr
$8K
2,845 claims · 0.0%
$8K
6,320 claims
$1.21
$57.85
Office/outpatient visit, new patient, low-mod complexity
$8K
6,320 claims · 0.0%
$7K
60K claims
$0.11
$7.18
Influenza virus vaccine, quadrivalent, preservative-free, IM
$7K
60K claims · 0.0%
$6K
5,989 claims · 0.0%
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