Planned Parenthood/orange and San Bernardino Counties, Inc.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 18 procedure codes: 99214 at 2.5× median, 99213 at 2.3× 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 $226.78 per claim for 99203 (Office/outpatient visit, new patient, low-mod complexity) — 3.9× the national median of $57.85.
Bills $251.69 per claim for 99204 (Office/outpatient visit, new patient, mod-high complexity) — 3.0× the national median of $84.03.
Bills $37.35 per claim for J3490 (Unclassified drugs) — 6.5× the national median of $5.70.
Billing in the top 1% nationally for 3 procedure codes: 99203, 99204, 90651.
This is a statistical summary, not an accusation. See our methodology.
Total Paid
$229.1M
$229,107,211
Total Claims
4.6M
Beneficiaries
4.2M
1.1 claims/patient
Avg Cost/Claim
$50
#366 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Planned Parenthood/orange and San Bernardino Counties, Inc. is a Clinic/Center, Ambulatory Family Planning Facility provider based in Orange, CA. From the 2018–2024 period, this provider received $229.1M in Medicaid payments across 4.6M claims.
Why This Matters
This provider received $229.1M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 28,638 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 (99214 (Office/outpatient visit, est. patient, mod-high complexity)) accounts for 13% of total spending.
$28.8M
219K claims
$131.78
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$28.8M
219K claims · 12.6%
$22.7M
26K claims
$873.90
$786.43
Etonogestrel implant system, including implant and supplies
$22.7M
26K claims · 9.9%
$20.0M
232K claims
$86.16
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$20.0M
232K claims · 8.7%
$17.9M
593K claims
$30.14
$24.95
Chlamydia detection, nucleic acid, amplified probe
$17.9M
593K claims · 7.8%
$16.9M
583K claims
$28.91
$23.39
Neisseria gonorrhoeae detection, nucleic acid, amplified probe
$16.9M
583K claims · 7.4%
$13.8M
101K claims · 6.0%
$10.9M
48K claims
$226.78
$57.85
Office/outpatient visit, new patient, low-mod complexity
$10.9M
48K claims · 4.8%
$10.0M
21K claims · 4.4%
$8.5M
34K claims
$251.69
$84.03
Office/outpatient visit, new patient, mod-high complexity
$8.5M
34K claims · 3.7%
Unclassified drugs
$8.1M
217K claims · 3.5%
$7.3M
9K claims · 3.2%
$6.5M
98K claims
$66.12
$25.06
Office/outpatient visit, low complexity
$6.5M
98K claims · 2.8%
$6.1M
29K claims · 2.7%
$5.5M
5K claims · 2.4%
$5.1M
217K claims · 2.2%
$5.1M
40K claims
$129.15
$40.11
Office/outpatient visit, new patient, low complexity
$5.1M
40K claims · 2.2%
$5.1M
7K claims · 2.2%
$4.0M
43K claims · 1.7%
$3.8M
434K claims · 1.7%
HPV vaccine, 9-valent
$3.3M
13K claims · 1.5%
$3.0M
56K claims · 1.3%
Urine pregnancy test
$1.9M
587K claims · 0.8%
$1.8M
24K claims
$75.15
$47.65
Ultrasound, pregnant uterus, transvaginal
$1.8M
24K claims · 0.8%
$1.4M
32K claims
$43.28
$12.93
Office/outpatient visit, minimal complexity
$1.4M
32K claims · 0.6%
$1.4M
9K claims · 0.6%
$1.1M
20K claims · 0.5%
$882K
31K claims · 0.4%
$777K
13K claims · 0.3%
$641K
4K claims · 0.3%
$626K
173K claims · 0.3%
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