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
▼
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
6K claims
$59.77
$37.22
Hospital discharge day management, 30 minutes or less
$336K
6K 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
3K claims
$64.65
$62.48
Initial hospital or birthing center care, newborn, per day
$214K
3K claims · 0.1%
Case management, each 15 min
$194K
17K claims · 0.1%
$192K
3K claims
$56.43
$35.30
Subsequent hospital care, per day, high complexity
$192K
3K claims · 0.1%
$130K
4K claims
$32.44
$16.77
Subsequent hospital care, per day, low complexity
$130K
4K claims · 0.0%
$103K
3K claims
$38.94
$23.99
Subsequent hospital care, per day, moderate complexity
$103K
3K 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
5K claims
$4.04
$84.03
Office/outpatient visit, new patient, mod-high complexity
$21K
5K claims · 0.0%
$21K
6K claims
$3.42
$96.18
Mental health assessment by non-physician
$21K
6K claims · 0.0%
Psychotherapy, 60 minutes
$20K
14K claims · 0.0%
$19K
7K claims · 0.0%
$14K
11K claims
$1.37
$74.09
Office/outpatient visit, high complexity
$14K
11K claims · 0.0%
$14K
4K claims
$3.90
$108.91
Psychiatric diagnostic evaluation with medical services
$14K
4K 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
3K claims
$2.81
$76.22
Preventive visit, new patient, 18-39 yr
$8K
3K claims · 0.0%
$8K
6K claims
$1.21
$57.85
Office/outpatient visit, new patient, low-mod complexity
$8K
6K claims · 0.0%
$7K
60K claims
$0.11
$7.18
Influenza virus vaccine, quadrivalent, preservative-free, IM
$7K
60K claims · 0.0%
$6K
6K claims · 0.0%
Other Top Providers in Arizona
View all →Acumen Fiscal Agent LLC
Community/Behavioral Health
$1.06B
Arion Care Solutions LLC
In Home Supportive Care
$606.7M
Phoenix Children's Hospital
General Acute Care Hospital Children
$555.7M
National Mentor Healthcare
Day Training, Developmentally Disabled Services
$459.7M
Mountain Park Health Center
Clinic/Center, Federally Qualified Health Center (
$352.1M
Similar Providers
Other top providers in Clinic/Center, Federally Qualified Health Center (FQHC)