Sun River Health Inc.
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $185.32 per claim for 90832 (Psychotherapy, 30 minutes), which is 4.5× the national median of $41.28.
Billing Swing
Experienced over 200% change in year-over-year billing with >$1M absolute change.
Billing changed from $20.6M (2018) to $77.1M (2019) — a 274% swing with $56.4M absolute change.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 41 procedure codes: 99213 at 2.8× median, 90832 at 4.5× 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:
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.
Billing Swing
Billing Swing means this provider's total billing changed dramatically from one year to the next — increasing or decreasing by more than 200% with over $1M in absolute change. This could indicate a change in practice scope, a billing scheme ramping up, or legitimate growth.
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
Bills $309.08 per claim for G9005 (Coordinated care fee, risk-adjusted, ESRD) — 6.6× the national median of $47.08.
Bills $185.32 per claim for 90832 (Psychotherapy, 30 minutes) — 4.5× the national median of $41.28.
Bills $286.53 per claim for T1016 (Case management, each 15 min) — 5.8× the national median of $49.62.
Billing above the 90th percentile for 12 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
This provider's total spending of $546.5M is at the 99th percentile among 24 Clinic/Center Federally Qualified Health Center (FQHC) providers.
Above 99th percentile for this specialty — higher spending than 23 of 24 peers
Total Paid
$546.5M
$546,516,639
Total Claims
5.0M
Beneficiaries
3.7M
1.3 claims/patient
Avg Cost/Claim
$110
#104 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Sun River Health Inc. is a Clinic/Center Federally Qualified Health Center (FQHC) provider based in Peekskill, NY. From the 2018–2024 period, this provider received $546.5M in Medicaid payments across 5.0M claims.
Why This Matters
This provider received $546.5M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 68,314 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 (G9005 (Coordinated care fee, risk-adjusted, ESRD)) accounts for 30% of total spending.
$161.8M
523K claims
$309.08
$47.08
Coordinated care fee, risk-adjusted, ESRD
$161.8M
523K claims · 29.6%
$140.9M
1.3M claims
$105.83
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$140.9M
1.3M claims · 25.8%
Psychotherapy, 30 minutes
$69.9M
377K claims · 12.8%
Case management, per month
$36.0M
64K claims · 6.6%
$32.4M
333K claims
$97.30
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$32.4M
333K claims · 5.9%
Case management, each 15 min
$20.4M
71K claims · 3.7%
$16.8M
204K claims
$82.28
$25.06
Office/outpatient visit, low complexity
$16.8M
204K claims · 3.1%
Psychotherapy, 45 minutes
$7.9M
38K claims · 1.4%
$5.0M
72K claims
$68.83
$75.18
Preventive medicine, established patient, age 1-4
$5.0M
72K claims · 0.9%
$4.7M
66K claims
$71.88
$69.35
Preventive medicine, established patient, infant (under 1)
$4.7M
66K claims · 0.9%
Psychiatric diagnostic evaluation
$4.7M
25K claims · 0.9%
$4.0M
58K claims
$68.31
$74.82
Preventive medicine, established patient, age 5-11
$4.0M
58K claims · 0.7%
Group psychotherapy
$3.3M
34K claims · 0.6%
$3.0M
88K claims
$33.56
$24.34
Periodic oral evaluation, established patient
$3.0M
88K claims · 0.5%
$2.4M
35K claims
$67.87
$80.15
Preventive medicine, established patient, age 12-17
$2.4M
35K claims · 0.4%
$2.0M
11K claims
$179.83
$108.91
Psychiatric diagnostic evaluation with medical services
$2.0M
11K claims · 0.4%
Global fee, urgent care centers
$1.9M
15K claims · 0.3%
$1.6M
20K claims
$80.77
$76.06
Preventive medicine, established patient, age 40-64
$1.6M
20K claims · 0.3%
$1.6M
27K claims
$59.85
$27.07
Limited oral evaluation, problem focused
$1.6M
27K claims · 0.3%
$1.6M
13K claims
$128.55
$74.09
Office/outpatient visit, high complexity
$1.6M
13K claims · 0.3%
$1.5M
49K claims
$31.57
$32.07
Comprehensive oral evaluation, new or established patient
$1.5M
49K claims · 0.3%
Prophylaxis, adult cleaning
$1.4M
26K claims · 0.3%
$1.2M
122K claims · 0.2%
Antepartum care only, 4-6 visits
$1.2M
12K claims · 0.2%
$1.2M
102K claims
$11.62
$17.85
Immunization administration, first vaccine/toxoid, with counseling
$1.2M
102K claims · 0.2%
$1.1M
13K claims
$85.44
$72.71
Preventive medicine, established patient, age 18-39
$1.1M
13K claims · 0.2%
$1.1M
11K claims
$98.67
$57.85
Office/outpatient visit, new patient, low-mod complexity
$1.1M
11K claims · 0.2%
$1.0M
24K claims
$43.20
$12.93
Office/outpatient visit, minimal complexity
$1.0M
24K claims · 0.2%
$953K
29K claims
$32.53
$21.91
Federally qualified health center visit, mental health
$953K
29K claims · 0.2%
$932K
11K claims
$86.54
$40.11
Office/outpatient visit, new patient, low complexity
$932K
11K claims · 0.2%
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