Alameda County Behavioral Health Care
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $221.90 per claim for T1017 (Targeted case management, per 15 min), which is 3.2× the national median of $69.56.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 39 procedure codes: S9484 at 10.9× median, H2017 at 3.0× median.
Unusually High Spending
This provider's total payments are significantly above the median for their specialty.
High Cost Per Claim
Average payment per claim is much higher than peers billing the same procedures.
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.
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.
Unusually High Spending
Unusually High Spending means this provider's total Medicaid payments are significantly above the median for their specialty. This doesn't necessarily indicate fraud — high volume practices and those serving complex populations may legitimately bill more.
High Cost Per Claim
High Cost Per Claim means each individual claim from this provider costs significantly more than what other providers charge for the same services. This could indicate upcoding (billing for more expensive services than provided) or legitimate specialized care.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Advanced Detection Signals
Additional statistical tests from advanced fraud detection methods
These signals use advanced statistical methods including digit distribution analysis, change-point detection, and market concentration metrics. Learn more.
Risk Assessment
Bills $2,713.31 per claim for S9484 (Crisis intervention mental health services, per hour) — 10.9× the national median of $249.51.
Bills $276.81 per claim for H2017 (Psychosocial rehabilitation services, per 15 min) — 3.0× the national median of $91.63.
Bills $281.58 per claim for H2010 (Comprehensive medication services, per 15 min) — 4.5× the national median of $62.69.
Billing in the top 1% nationally for 5 procedure codes: 90837, 99214, 99215.
This is a statistical summary, not an accusation. See our methodology.
Compared to Community/Behavioral Health Peers
Total spending distribution among 218 providers in this specialty
This provider's total spending of $1.07B is at the 90th percentile among 218 Community/Behavioral Health providers.
Above 90th percentile for this specialty — higher spending than 196 of 218 peers
Total Paid
$1.07B
$1,068,150,355
Total Claims
6.1M
Beneficiaries
1.3M
4.9 claims/patient
Avg Cost/Claim
$174
#30 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Alameda County Behavioral Health Care is a Community/Behavioral Health provider based in Oakland, CA. From the 2018–2024 period, this provider received $1.1B in Medicaid payments across 6.1M 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 $1.1B in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 133,518 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 (H2015 (Comprehensive community support services, per 15 min)) accounts for 31% of total spending.
$327.8M
1.2M claims
$275.94
$96.24
Comprehensive community support services, per 15 min
$327.8M
1.2M claims · 30.7%
$150.8M
56K claims
$2,713.31
$249.51
Crisis intervention mental health services, per hour
$150.8M
56K claims · 14.1%
$139.7M
505K claims
$276.81
$91.63
Psychosocial rehabilitation services, per 15 min
$139.7M
505K claims · 13.1%
$85.4M
303K claims
$281.58
$62.69
Comprehensive medication services, per 15 min
$85.4M
303K claims · 8.0%
$67.2M
303K claims
$221.90
$69.56
Targeted case management, per 15 min
$67.2M
303K claims · 6.3%
$49.9M
199K claims
$250.65
$80.64
Mental health service plan development
$49.9M
199K claims · 4.7%
$37.3M
2.6M claims
$14.45
$18.95
Alcohol/drug services; methadone administration
$37.3M
2.6M claims · 3.5%
$29.3M
11K claims
$2,638.02
$841.93
Psychiatric health facility service, per diem
$29.3M
11K claims · 2.7%
$28.8M
55K claims
$524.45
$467.51
Behavioral health; short-term residential, per diem
$28.8M
55K claims · 2.7%
$26.1M
274K claims
$95.17
$74.63
Behavioral health counseling & therapy, per 15 min
$26.1M
274K claims · 2.4%
$21.6M
66K claims
$328.87
$84.12
Therapeutic behavioral services, per 15 min
$21.6M
66K claims · 2.0%
$19.5M
105K claims
$185.77
$357.16
Behavioral health; residential, per diem
$19.5M
105K claims · 1.8%
$19.3M
222K claims
$87.11
$47.35
Alcohol and/or drug services, group counseling
$19.3M
222K claims · 1.8%
Psychotherapy, 60 minutes
$12.1M
40K claims · 1.1%
$9.2M
38K claims
$243.35
$56.90
Medication training and management, per 15 min
$9.2M
38K claims · 0.9%
$6.2M
16K claims
$388.41
$215.80
Crisis intervention service, per 15 minutes
$6.2M
16K claims · 0.6%
$5.6M
27K claims
$207.66
$72.96
Prolonged office/outpatient E/M, each additional 15 min
$5.6M
27K claims · 0.5%
$4.5M
9K claims
$514.48
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$4.5M
9K claims · 0.4%
$3.5M
27K claims
$133.81
$129.75
Alcohol and/or drug abuse, intensive outpatient, per hour
$3.5M
27K claims · 0.3%
$3.3M
4K claims
$771.24
$74.09
Office/outpatient visit, high complexity
$3.3M
4K claims · 0.3%
$3.0M
14K claims · 0.3%
$2.8M
7K claims
$386.90
$96.18
Mental health assessment by non-physician
$2.8M
7K claims · 0.3%
$2.4M
17K claims
$141.77
$43.10
Alcohol and/or drug services, case management
$2.4M
17K claims · 0.2%
$2.2M
1K claims
$1,594.24
$35.30
Subsequent hospital care, per day, high complexity
$2.2M
1K claims · 0.2%
Psychotherapy, 45 minutes
$2.2M
9K claims · 0.2%
$1.4M
5K claims
$287.87
$77.33
Family psychotherapy with patient, 50 min
$1.4M
5K claims · 0.1%
$1.2M
13K claims
$89.25
$137.86
Behavioral health day treatment, per hour
$1.2M
13K claims · 0.1%
$973K
3K claims
$365.11
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$973K
3K claims · 0.1%
$732K
4K claims · 0.1%
$657K
4K claims · 0.1%
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