County of Santa Clara
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $431.99 per claim for T1015 (Clinic visit/encounter, all-inclusive), which is 3.6× the national median of $121.16.
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.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Bills $431.99 per claim for T1015 (Clinic visit/encounter, all-inclusive) — 3.6× the national median of $121.16.
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 $175.9M is at the 75th percentile among 24 Clinic/Center Federally Qualified Health Center (FQHC) providers.
Total Paid
$175.9M
$175,858,802
Total Claims
1.4M
Beneficiaries
1.1M
1.3 claims/patient
Avg Cost/Claim
$127
#552 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
County of Santa Clara is a Clinic/Center Federally Qualified Health Center (FQHC) provider based in San Jose, CA. From the 2018–2024 period, this provider received $175.9M in Medicaid payments across 1.4M 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 $175.9M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 21,982 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 (T1015 (Clinic visit/encounter, all-inclusive)) accounts for 99% of total spending.
$173.5M
402K claims
$431.99
$121.16
Clinic visit/encounter, all-inclusive
$173.5M
402K claims · 98.7%
$665K
229K claims
$2.91
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$665K
229K claims · 0.4%
$211K
55K claims
$3.87
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$211K
55K claims · 0.1%
$159K
83K claims
$1.93
$25.06
Office/outpatient visit, low complexity
$159K
83K claims · 0.1%
$158K
40K claims
$4.00
$75.18
Preventive medicine, established patient, age 1-4
$158K
40K claims · 0.1%
$136K
33K claims
$4.15
$69.35
Preventive medicine, established patient, infant (under 1)
$136K
33K claims · 0.1%
$105K
21K claims
$5.03
$74.82
Preventive medicine, established patient, age 5-11
$105K
21K claims · 0.1%
HPV vaccine, 9-valent
$78K
4,782 claims · 0.0%
$77K
492 claims
$156.50
$66.78
Coordination of long-term care services, per month
$77K
492 claims · 0.0%
$48K
8,915 claims
$5.41
$80.15
Preventive medicine, established patient, age 12-17
$48K
8,915 claims · 0.0%
$47K
6,636 claims
$7.06
$24.95
Chlamydia detection, nucleic acid, amplified probe
$47K
6,636 claims · 0.0%
$46K
6,604 claims
$7.02
$23.39
Neisseria gonorrhoeae detection, nucleic acid, amplified probe
$46K
6,604 claims · 0.0%
$45K
600 claims
$75.22
$137.85
Other specified case management service, per 15 minutes
$45K
600 claims · 0.0%
$40K
1,388 claims · 0.0%
$38K
7,996 claims
$4.80
$74.09
Office/outpatient visit, high complexity
$38K
7,996 claims · 0.0%
$30K
2,789 claims
$10.90
$121.58
Office or other outpatient consultation, moderate complexity
$30K
2,789 claims · 0.0%
$27K
3,484 claims
$7.85
$82.43
Office or other outpatient consultation, low complexity
$27K
3,484 claims · 0.0%
$24K
3,399 claims · 0.0%
$24K
6,886 claims
$3.54
$19.06
Cytopathology, cervical or vaginal, ThinPrep
$24K
6,886 claims · 0.0%
$21K
1,385 claims · 0.0%
$20K
3,953 claims
$4.94
$39.33
Screening mammography, bilateral, including CAD
$20K
3,953 claims · 0.0%
$19K
1,845 claims
$10.52
$39.70
COVID-19 SARS-CoV-2 amplified probe detection
$19K
1,845 claims · 0.0%
$19K
1,243 claims · 0.0%
$17K
9,302 claims · 0.0%
$16K
2,441 claims
$6.52
$36.79
Ultrasound, pregnant uterus, limited
$16K
2,441 claims · 0.0%
$15K
2,030 claims · 0.0%
Tdap vaccine
$13K
2,404 claims · 0.0%
$12K
797 claims · 0.0%
$12K
797 claims
$15.13
$102.95
Developmental test administration
$12K
797 claims · 0.0%
$12K
1,399 claims
$8.32
$21.08
Trichomonas vaginalis detection, nucleic acid, amplified probe
$12K
1,399 claims · 0.0%
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