Statistical flags indicate unusual patterns — not proof of fraud or wrongdoing. Read our methodology

Contra Costa County

Clinic/Center Federally Qualified Health Center (FQHC)·Pittsburg, CA·NPI: 1568540763SharePrint Report
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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:

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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

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Bills $192.82 per claim for G0467 (Federally qualified health center visit, mental health) — 8.8× the national median of $21.91.

•

Bills $9.82 per claim for S0197 — 6.5× the national median of $1.50.

•

Billing above the 90th percentile for 6 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

P25MedianP75P90

This provider's total spending of $202.2M is at the 75th percentile among 24 Clinic/Center Federally Qualified Health Center (FQHC) providers.

Active Billing Period:2018-01→2024-12(84 months)

Total Paid

$202.2M

$202,196,038

Total Claims

2.5M

Beneficiaries

1.9M

1.3 claims/patient

Avg Cost/Claim

$80

#447 of 618K providers by total spending(top <0.1%)

🔍 Analysis

Provider Overview

Contra Costa County is a Clinic/Center Federally Qualified Health Center (FQHC) provider based in Pittsburg, CA. From the 2018–2024 period, this provider received $202.2M in Medicaid payments across 2.5M 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 $202.2M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 25,274 Medicaid beneficiaries for a full year at average per-enrollee costs.

↓ 9% growthsince first billing year

Monthly Spending Trend

Yearly Spending

2018
$32.3M
-15%
2019
$27.5M
-4%
2020
$26.5M
+25%
2021
$33.2M
-24%
2022
$25.1M
+13%
2023
$28.2M
+5%
2024
$29.5M

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 80% of total spending.

T1015Top 5%

Clinic visit/encounter, all-inclusive

$160.8M

470K claims · 79.5%

Your Cost: $342.00/claim|Median: $121.16
2.8× median
0510Top 10%

Revenue code, clinic services

$30.3M

372K claims · 15.0%

Your Cost: $81.46/claim|Median: $28.38
2.9× median
00003Top 25%

Anesthesia services

$7.6M

18K claims · 3.7%

Your Cost: $427.94/claim|Median: $223.77
1.9× median
G0467Top 5%

Federally qualified health center visit, mental health

$1.8M

10K claims · 0.9%

Your Cost: $192.82/claim|Median: $21.91
8.8× median
99078Normal range

$452K

15K claims · 0.2%

Your Cost: $29.95/claim|Median: $25.66
1.2× median
96164Top 10%

$232K

11K claims · 0.1%

Your Cost: $21.29/claim|Median: $9.87
2.2× median
0002ANormal range

COVID-19 vaccine admin, Pfizer, 2nd dose

$194K

10K claims · 0.1%

Your Cost: $19.73/claim|Median: $36.70
0.5× median
0001ANormal range

COVID-19 vaccine admin, Pfizer, 1st dose

$186K

11K claims · 0.1%

Your Cost: $17.57/claim|Median: $33.72
0.5× median
90832Normal range

Psychotherapy, 30 minutes

$86K

4K claims · 0.0%

Your Cost: $23.95/claim|Median: $41.28
0.6× median
96152Normal range

Health behavior intervention, individual

$70K

2K claims · 0.0%

Your Cost: $29.35/claim|Median: $20.02
1.5× median
0004ANormal range

$55K

1K claims · 0.0%

Your Cost: $39.73/claim|Median: $35.62
1.1× median
96158Normal range

$49K

2K claims · 0.0%

Your Cost: $20.26/claim|Median: $28.43
0.7× median
90791Normal range

Psychiatric diagnostic evaluation

$45K

2K claims · 0.0%

Your Cost: $25.12/claim|Median: $99.21
0.3× median
0054ATop 25%

$45K

1K claims · 0.0%

Your Cost: $41.27/claim|Median: $35.83
1.1× median
0124ATop 25%

$34K

727 claims · 0.0%

Your Cost: $47.09/claim|Median: $34.32
1.4× median
90837Normal range

Psychotherapy, 60 minutes

$32K

1K claims · 0.0%

Your Cost: $31.01/claim|Median: $85.66
0.4× median
90853Top 25%

Group psychotherapy

$23K

560 claims · 0.0%

Your Cost: $41.02/claim|Median: $25.02
1.6× median
0064ANormal range

$22K

565 claims · 0.0%

Your Cost: $39.65/claim|Median: $34.17
1.2× median
0011ANormal range

COVID-19 vaccine admin, Moderna, 1st dose

$19K

2K claims · 0.0%

Your Cost: $11.16/claim|Median: $25.93
0.4× median
0012ANormal range

COVID-19 vaccine admin, Moderna, 2nd dose

$18K

2K claims · 0.0%

Your Cost: $11.08/claim|Median: $33.85
0.3× median
99213Normal range

Office/outpatient visit, est. patient, low-mod complexity

$15K

296K claims · 0.0%

Your Cost: $0.05/claim|Median: $37.81
0.0× median
99391Normal range

Preventive medicine, established patient, infant (under 1)

$14K

13K claims · 0.0%

Your Cost: $1.09/claim|Median: $69.35
0.0× median
S0197Top 5%

$14K

1K claims · 0.0%

Your Cost: $9.82/claim|Median: $1.50
6.5× median
0071ANormal range

$13K

339 claims · 0.0%

Your Cost: $39.76/claim|Median: $38.71
1.0× median
90834Normal range

Psychotherapy, 45 minutes

$12K

322 claims · 0.0%

Your Cost: $38.73/claim|Median: $63.65
0.6× median
0052ANormal range

$9K

220 claims · 0.0%

Your Cost: $40.00/claim|Median: $37.79
1.1× median
96159Normal range

$8K

2K claims · 0.0%

Your Cost: $3.56/claim|Median: $20.68
0.2× median
99401Normal range

$7K

320 claims · 0.0%

Your Cost: $21.54/claim|Median: $16.53
1.3× median
0134ATop 10%

$7K

105 claims · 0.0%

Your Cost: $64.45/claim|Median: $33.54
1.9× median
91322Normal range

$6K

249 claims · 0.0%

Your Cost: $22.45/claim|Median: $76.28
0.3× median

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

City & County of San Francisco

Community/Behavioral Health

$1.34B

Los Angeles County Department of Public Health

Public Health or Welfare

$1.13B

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