County of Santa Cruz
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 21 procedure codes: H2017 at 2.9× median, H2015 at 4.4× 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.
Risk Assessment
Bills $419.65 per claim for H2015 (Comprehensive community support services, per 15 min) — 4.4× the national median of $96.24.
Bills $367.01 per claim for T1017 (Targeted case management, per 15 min) — 5.3× the national median of $69.56.
Bills $2,810.53 per claim for S9484 (Crisis intervention mental health services, per hour) — 11.3× the national median of $249.51.
Billing in the top 1% nationally for 1 procedure code: 90837.
This is a statistical summary, not an accusation. See our methodology.
Compared to Clinic/Center Peers
Total spending distribution among 13 providers in this specialty
This provider's total spending of $276.3M is at the 90th percentile among 13 Clinic/Center providers.
Above 90th percentile for this specialty — higher spending than 11 of 13 peers
Total Paid
$276.3M
$276,252,681
Total Claims
1.7M
Beneficiaries
260K
6.5 claims/patient
Avg Cost/Claim
$163
#285 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
County of Santa Cruz is a Clinic/Center provider based in Santa Cruz, CA. From the 2018–2024 period, this provider received $276.3M in Medicaid payments across 1.7M 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 $276.3M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 34,531 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 (H2017 (Psychosocial rehabilitation services, per 15 min)) accounts for 27% of total spending.
$75.1M
283K claims
$265.06
$91.63
Psychosocial rehabilitation services, per 15 min
$75.1M
283K claims · 27.2%
$55.5M
132K claims
$419.65
$96.24
Comprehensive community support services, per 15 min
$55.5M
132K claims · 20.1%
$42.0M
153K claims
$273.63
$357.16
Behavioral health; residential, per diem
$42.0M
153K claims · 15.2%
Targeted case management, per 15 min
$22.2M
60K claims · 8.0%
$17.6M
6K claims
$2,810.53
$249.51
Crisis intervention mental health services, per hour
$17.6M
6K claims · 6.4%
$12.8M
870K claims
$14.73
$18.95
Alcohol/drug services; methadone administration
$12.8M
870K claims · 4.6%
$8.5M
18K claims
$461.78
$62.69
Comprehensive medication services, per 15 min
$8.5M
18K claims · 3.1%
$8.1M
22K claims
$366.59
$80.64
Mental health service plan development
$8.1M
22K claims · 2.9%
$7.2M
16K claims
$461.83
$467.51
Behavioral health; short-term residential, per diem
$7.2M
16K claims · 2.6%
$5.8M
46K claims
$125.38
$74.63
Behavioral health counseling & therapy, per 15 min
$5.8M
46K claims · 2.1%
$5.0M
6K claims
$854.39
$215.80
Crisis intervention service, per 15 minutes
$5.0M
6K claims · 1.8%
$3.7M
11K claims · 1.3%
Psychotherapy, 60 minutes
$3.3M
8K claims · 1.2%
$1.6M
13K claims
$118.39
$43.10
Alcohol and/or drug services, case management
$1.6M
13K claims · 0.6%
$1.6M
10K claims
$149.22
$129.75
Alcohol and/or drug abuse, intensive outpatient, per hour
$1.6M
10K claims · 0.6%
$1.4M
9K claims
$163.27
$47.35
Alcohol and/or drug services, group counseling
$1.4M
9K claims · 0.5%
$976K
5K claims
$216.02
$72.96
Prolonged office/outpatient E/M, each additional 15 min
$976K
5K claims · 0.4%
$857K
2K claims
$414.42
$84.12
Therapeutic behavioral services, per 15 min
$857K
2K claims · 0.3%
$591K
2K claims
$389.85
$56.90
Medication training and management, per 15 min
$591K
2K claims · 0.2%
$590K
895 claims · 0.2%
$444K
1K claims
$302.26
$96.18
Mental health assessment by non-physician
$444K
1K claims · 0.2%
Psychotherapy, 45 minutes
$280K
1K claims · 0.1%
Psychiatric diagnostic evaluation
$245K
3K claims · 0.1%
$227K
869 claims
$260.67
$64.10
Alcohol/drug services, treatment plan review
$227K
869 claims · 0.1%
$179K
550 claims
$325.75
$77.33
Family psychotherapy with patient, 50 min
$179K
550 claims · 0.1%
$148K
487 claims
$304.50
$83.98
Psychotherapy for crisis, first 60 min
$148K
487 claims · 0.1%
$83K
264 claims · 0.0%
$77K
779 claims
$99.46
$55.04
Self-help/peer services, per 15 minutes
$77K
779 claims · 0.0%
$77K
142 claims · 0.0%
$70K
13K claims
$5.36
$137.85
Other specified case management service, per 15 minutes
$70K
13K claims · 0.0%
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