Genetic Disease Screening Program State of CA
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $220.83 per claim for 81508, which is 8.4× the national median of $26.27.
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.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Bills $220.83 per claim for 81508 — 8.4× the national median of $26.27.
Bills $220.71 per claim for 81511 — 4.5× the national median of $48.74.
Bills $84.83 per claim for 82105 — 7.6× the national median of $11.11.
Billing in the top 1% nationally for 1 procedure code: 82105.
This is a statistical summary, not an accusation. See our methodology.
Compared to Clinical Medical Laboratory Peers
Total spending distribution among 88 providers in this specialty
This provider's total spending of $182.5M is at the 50th percentile among 88 Clinical Medical Laboratory providers.
Total Paid
$182.5M
$182,456,075
Total Claims
926K
Beneficiaries
848K
1.1 claims/patient
Avg Cost/Claim
$197
#521 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Genetic Disease Screening Program State of CA is a Clinical Medical Laboratory provider based in Richmond, CA. From the 2018–2024 period, this provider received $182.5M in Medicaid payments across 926K 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 $182.5M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 22,807 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 6 distinct procedure codes. The top code (81508) accounts for 45% of total spending.
$82.9M
376K claims · 45.4%
$50.6M
229K claims · 27.7%
$27.8M
120K claims
$231.40
$358.21
Fetal chromosomal aneuploidy genomic sequence analysis
$27.8M
120K claims · 15.2%
$14.5M
171K claims · 7.9%
$6.0M
26K claims · 3.3%
Newborn metabolic screening panel
$724K
4K claims · 0.4%
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