Alameda County Behavioral Health Care
Community/Behavioral Health
Oakland, California
NPI: 1659402303
Risk Tier
Critical
Total Paid
$1.07B
$1,068,150,355
Total Claims
6.1M
Beneficiaries
1.3M
Avg Cost/Claim
$174.01
Active billing period: 76 months (2018-01 to 2024-04)
Statistical Fraud Flags (4)
Cost Outlier
Billing over 3× the national median for specific procedure codes.
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.
Advanced Detection Signals
Billing Velocity
3671.3 claims per working day — may exceed physically possible volume for a single provider.
Disclaimer: Statistical flags indicate unusual billing patterns — they are not proof of fraud or wrongdoing. Some entities (government agencies, home care programs, hospitals) may legitimately bill at higher rates due to patient acuity, overhead costs, or specialized services. This report is generated from public HHS data and statistical analysis only. No clinical or investigative review has been performed.
Generated by OpenMedicaid | openmedicaid.org | Data: HHS 2018-2024