Providers
All 30 in CA
SOMA KRISHNAMOORTHI, M.D.
NPI 1013011055, individual, Escalon, CA, Internal Medicine
2
Evidence tier
impossible volume with concurrency
- Billed more hands-on hours than a day holds in 1 month, peaking at 131.2 hours per day across 3 billing organizations.
- Medicaid dollars per patient on code 90686 ($340 per patient-month) sit in the top 5% of every provider billing that code.
score 84 of 100, rank 709, $210K at stake
Hours billed per day
Medicaid billing converted into hours of hands-on care per day. The lower bound counts one unit per claim line and needs no price; the other two divide dollars by a unit price, the conservative one at 1.5 times the price. The clinician on the claim may be a supervisor under state rules, so billing organizations are counted too.
| month | what was found | hours per day, lower bound | hours per day, at price | hours per day, conservative | per working day | patients | billing organizations | codes | paid |
|---|---|---|---|---|---|---|---|---|---|
| Oct 2022 | More hours than a day holds at a conservative unit price | 5.5 | 196.7 | 131.2 | 193.6 | 258 | 1 | 99213 99214 | $210K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | SOMA KRISHNAMOORTHI, M.D. |
| Type | Individual |
| Status | Active |
| NPI issued | September 11, 2006, last updated May 3, 2011 |
| Practice location | 850 W CALIFORNIA STREET, Escalon, CA 95320-1506, 209-838-2278 |
| Specialties | Internal Medicine (207R00000X, primary, license A76562 CA) |
Procedures billed
The specific codes behind the dollars. Medicaid figures come from T-MSIS (2018 to 2024) and are compared with every other provider billing the same code; Medicare figures come from the 2024 physician and supplier file and compare this provider's submitted charge with what Medicare allowed, against the usual ratio for that code.
Medicaid, largest codes
| code | what it is | paid | share | per patient-month | typical | rank among providers | |
|---|---|---|---|---|---|---|---|
| T1015 | Medicaid service code | $1.8M | 54% | $83 | $182 (top 5% from $488) | 18th percentile | |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | $673K | 20% | $36 | $44 (top 5% from $110) | 38th percentile | |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $236K | 7% | $41 | $60 (top 5% from $133) | 25th percentile | |
| 90471 | Administration of vaccine | $228K | 7% | $94 | $10 (top 5% from $23) | 100th percentile | |
| 90686 | Influenza vaccine, quadrivalent, preservative free, 0.5 ml dosage | $211K | 6% | $340 | $2.30 (top 5% from $20) | 100th percentile | |
| G0467 | Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a t | $48K | 1% | $23 | $20 (top 5% from $124) | 55th percentile | |
| 96372 | Injection of drug or substance under skin or into muscle | $31K | 1% | $17 | $12 (top 5% from $49) | 74th percentile | |
| 87811 | Detection test by immunoassay with direct visual observation for severe acute respiratory syndrome coronavirus 2 (covid-19) | $20K | 1% | $36 | $33 (top 5% from $45) | 64th percentile |
Medicare Part B 2024, largest codes
| code | what it is | services | beneficiaries | paid | submitted per service | allowed per service | charge to allowed | usual for this code |
|---|---|---|---|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | 484 | 193 | $32K | $200 | $96 | 2.1x | 2.2x (90th percentile 3.8x) |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | 113 | 80 | $11K | $252 | $137 | 1.8x | 2.3x (90th percentile 3.8x) |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 63 | 63 | $9K | $183 | $143 | 1.3x | 2.3x (90th percentile 4.1x) |
| 90653 | Influenza vaccine, inactivated | 37 | 36 | $3K | $249 | $82 | 3.0x | 1.1x (90th percentile 2.0x) |
| 90732 | Pneumococcal vaccine, 23-valent | 23 | 23 | $3K | $174 | $131 | 1.3x | 1.3x (90th percentile 2.3x) |
| 99496 | Transitional care management services for problem of high complexity | 12 | 12 | $3K | $342 | $301 | 1.1x | 1.9x (90th percentile 3.1x) |
| 87811 | Detection test by immunoassay with direct visual observation for severe acute respiratory syndrome coronavirus 2 (covid-19) | 51 | 42 | $2K | $95 | $41 | 2.3x | 2.1x (90th percentile 4.3x) |
| G0008 | Administration of influenza virus vaccine | 52 | 49 | $2K | $45 | $33 | 1.4x | 1.2x (90th percentile 2.3x) |
A submitted charge many times the allowed amount is common and lawful; it matters when it is far above what other providers submit for the same code.
In this area
30 providers in San Joaquin County, CA carry an indicator in the public record, with $75.7M at stake between them. The most common is more hours than a day holds, on 19 of them, followed by part of a provider network on 11.
| tier | provider | at stake | why |
|---|---|---|---|
| 3 | WESTERN HEALTH RESOURCES Lodi, CA, ranked 1292 | $175K |
|
| 3 | PROHEALTH HOME CARE, INC Stockton, CA, ranked 1389 | $71K |
|
| 3 | AMERIPRIME HEALTHCARE INC. Tracy, CA, ranked 1481 | $24K |
|
| 3 | DEERGRASS HEALTHCARE, INC. Lodi, CA, ranked 1804 | $0 |
|
| 3 | STOCKTON HEALTH CARE SERVICES, INC. Stockton, CA, ranked 2410 | $0 |
|
| 3 | NOBLE CARE CENTER LLC Stockton, CA, ranked 3556 | $0 |
|
| 3 | PROHEALTH HOME CARE, INC Stockton, CA, ranked 3928 | $0 |
|
| 3 | STOCKTON EDISON HEALTHCARE CORPORATION Stockton, CA, ranked 4350 | $0 |
|
Recent enforcement in CA
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
DOJPleaded guiltyAug 27, 2026
Anaheim Woman Pleads Guilty to Submitting More Than $2.2 Million in Fraudulent Hospice Care Claims to Medicare
Galbraith submitted approximately $2,266,694 in claims to Medicare for hospice services for beneficiaries who did not have a terminal illness with a life expectancy of six months or less, and Medicare paid her company approximately $2,140,606.
DOJCivil settlementAug 26, 2026
DermTech Inc. to Pay Up to $5M to Resolve Allegations It Submitted False Claims to Medicare for Unreliable Skin Cancer Tests
DermTech Inc. submitted claims to Medicare for skin cancer tests conducted with an unvalidated positive control range and for tests lacking sufficient patient RNA, and did not retract results or adequately refund Medicare.
DOJCivil settlementAug 26, 2026
DermTech Inc. to Pay Up to $5M to Resolve Allegations It Submitted False Claims to Medicare for Unreliable Skin Cancer Tests
DermTech Inc. billed Medicare for skin cancer tests conducted using an unvalidated positive control range and for tests with insufficient patient RNA, and did not retract the results or adequately refund Medicare.
DOJCivil settlementAug 24, 2026
Medicare Advantage Provider Monogram Health Agrees to Pay $2.4 Million to Settle False Claims Act Lawsuit
Monogram knowingly submitted diagnosis codes in four HCCs that were not clinically accurate, not supported by medical record documentation, and/or did not require or affect patient care, inflating Medicare Advantage beneficiaries' risk scores and causing CMS to make higher capitated payments to Medicare Advantage Organizations.
DOJCivil settlementAug 24, 2026
Medicare Advantage Provider Monogram Health Agrees to Pay $2.4M to Settle False Claims Act Suit
Monogram Health knowingly submitted diagnosis codes within four HCCs that were not clinically accurate, not supported by medical record documentation, and/or did not require or affect patient care, inflating Medicare Advantage beneficiaries' risk scores and causing CMS to make higher capitated payments to MAOs.
Referral packet
The packet is a draft for a reviewer. It reads every public record behind this case, states what the records show with a citation for each finding, names the regulation each finding relates to, and lists the ordinary explanations to rule out first. It never asserts intent.