La Maestra Family Clinic, Inc.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 4 procedure codes: 0064A at 1.5× median, 0072A at 1.4× 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.
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 $202.1M is at the 75th percentile among 16 Clinic/Center, Federally Qualified Health Center (FQHC) providers.
Total Paid
$202.1M
$202,136,402
Total Claims
3.5M
Beneficiaries
2.7M
1.3 claims/patient
Avg Cost/Claim
$58
#448 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
La Maestra Family Clinic, Inc. is a Clinic/Center, Federally Qualified Health Center (FQHC) provider based in San Diego, CA. From the 2018–2024 period, this provider received $202.1M in Medicaid payments across 3.5M claims.
Why This Matters
This provider received $202.1M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 25,267 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 66% of total spending.
$134.4M
703K claims
$191.13
$121.16
Clinic visit/encounter, all-inclusive
$134.4M
703K claims · 66.5%
Anesthesia services
$56.8M
212K claims · 28.1%
$4.3M
35K claims
$125.14
$137.85
Other specified case management service, per 15 minutes
$4.3M
35K claims · 2.1%
$1.1M
353K claims
$3.00
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$1.1M
353K claims · 0.5%
$687K
63K claims · 0.3%
$656K
133K claims
$4.92
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$656K
133K claims · 0.3%
$578K
2,915 claims
$198.15
$66.78
Coordination of long-term care services, per month
$578K
2,915 claims · 0.3%
Antepartum care only, 4-6 visits
$500K
10K claims · 0.2%
Psychotherapy, 30 minutes
$445K
37K claims · 0.2%
Psychotherapy, 45 minutes
$193K
6,657 claims · 0.1%
$186K
3,400 claims
$54.69
$99.21
Psychiatric diagnostic evaluation
$186K
3,400 claims · 0.1%
$156K
60K claims · 0.1%
$137K
149K claims · 0.1%
$122K
2,301 claims
$53.17
$58.16
Ultrasound, pregnant uterus, single fetus, first trimester
$122K
2,301 claims · 0.1%
$112K
110K claims
$1.01
$25.06
Office/outpatient visit, low complexity
$112K
110K claims · 0.1%
$108K
7,742 claims
$13.89
$47.08
Ophthalmological exam, comprehensive, established patient
$108K
7,742 claims · 0.1%
$85K
2,003 claims · 0.0%
$77K
1,197 claims
$64.15
$74.78
Ultrasound, pregnant uterus, complete, single fetus
$77K
1,197 claims · 0.0%
$67K
6,625 claims
$10.04
$72.71
Preventive medicine, established patient, age 18-39
$67K
6,625 claims · 0.0%
$63K
12K claims · 0.0%
$63K
3,807 claims
$16.47
$74.09
Office/outpatient visit, high complexity
$63K
3,807 claims · 0.0%
$63K
5,870 claims
$10.68
$76.06
Preventive medicine, established patient, age 40-64
$63K
5,870 claims · 0.0%
$58K
1,475 claims
$39.29
$33.85
COVID-19 vaccine admin, Moderna, 2nd dose
$58K
1,475 claims · 0.0%
$53K
1,245 claims
$42.74
$114.71
Comprehensive multidisciplinary evaluation
$53K
1,245 claims · 0.0%
$50K
27K claims
$1.85
$7.18
Influenza virus vaccine, quadrivalent, preservative-free, IM
$50K
27K claims · 0.0%
$49K
5,820 claims
$8.39
$57.85
Office/outpatient visit, new patient, low-mod complexity
$49K
5,820 claims · 0.0%
$40K
14K claims
$2.83
$75.18
Preventive medicine, established patient, age 1-4
$40K
14K claims · 0.0%
$39K
56K claims
$0.70
$6.61
Screening audiometry, pure tone, air only
$39K
56K claims · 0.0%
$39K
1,528 claims
$25.38
$108.91
Psychiatric diagnostic evaluation with medical services
$39K
1,528 claims · 0.0%
$35K
2,010 claims
$17.56
$21.91
Federally qualified health center visit, mental health
$35K
2,010 claims · 0.0%
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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