ARNALDO CRUZ IGARTUA, M.D.

NPI 1013110899, individual, San Juan, PR, Psychiatry & Neurology, Addiction Psychiatry

Evidence tier

structure or single-organization volume

Hours beyond a day in 1 month, but with up to 683 patients a month, which points to a supervising clinician on the claims rather than one person's hours.
Records needed.

score 51 of 100, rank 8890, $1.3M 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
Sep 2022	More hours than a day holds, even counting one unit per claim line	28.2	25.6	17.1	23.3	683	2	90791 90834 90837 99213 99214	$87K

National provider registry

From the CMS NPPES Registry, refreshed daily.

Name	ARNALDO CRUZ IGARTUA, M.D.
Type	Individual, sole proprietor
Status	Active
NPI issued	June 7, 2007, last updated November 17, 2022
Practice location	1513 CALLE PARANA, URB. EL PARAISO, San Juan, PR 00926-2814, 787-764-8479
Mailing address	317 CALLE INTERAMERICANA, UNIVERSITY GARDENS, San Juan, PR 00927-4011
Specialties	Psychiatry & Neurology, Addiction Psychiatry (2084P0802X, primary, license 7654 PR)

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
90834	Psychotherapy, 45 minutes	$1.2M	73%	$210	$101 (top 5% from $318)	86th percentile
99214	Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	$232K	14%	$81	$60 (top 5% from $133)	72nd percentile
90837	Psychotherapy, 1 hourhistory of abuse	$85K	5%	$179	$191 (top 5% from $442)	44th percentile
99213	Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more	$66K	4%	$70	$44 (top 5% from $110)	82nd percentile
90791	Psychiatric diagnostic evaluation	$32K	2%	$124	$105 (top 5% from $228)	69th percentile
90882	Medicaid service code	$24K	1%	$307	$78 (top 5% from $209)	98th percentile

In this area

12 providers in San Juan Municipio County, PR carry an indicator in the public record, with $3.9M at stake between them. The most common is more hours than a day holds, on 8 of them, followed by named in an enforcement record on 3. 3 are tier 1: documented action, then payment.

tier	provider	at stake	why
1	PHYSICIAN H.M.O. INC. San Juan, PR, ranked 158	$81K	Adjudicated (pleaded guilty) per a Department of Justice release dated July 17, 2025. Medicaid paid $81,097 in the last 12 observed months.
1	PHYSICIAN HMO INC. San Juan, PR, ranked 408	$680	Adjudicated (pleaded guilty) per a Department of Justice release dated July 17, 2025. Medicaid paid $680 in the last 12 observed months.
1	PHYSICIAN HMO INC. Rio Piedras, PR, ranked 460	$0	Adjudicated (pleaded guilty) per a Department of Justice release dated July 17, 2025. No Medicaid payments in the last 12 observed months.
3	CMS HOME CARE METRO, LLC. San Juan, PR, ranked 5251	$0	Part of provider network D1-00068, ranked 68 nationally.
4	FRANKIE ALVARADO San Juan, PR, ranked 7831	$1.0M	Hours beyond a day in 3 months under one organization, which can be supervisory billing. Records needed. and 1 more
4	JAN RODRIGUEZ FERRER San Juan, PR, ranked 7946	$483K	Hours beyond a day in 2 months under one organization, which can be supervisory billing. Records needed. and 1 more
4	WALESKA LIND San Juan, PR, ranked 9521	$144K	Hours beyond a day in 2 months, but with up to 224 patients a month, which points to a supervising clinician on the claims rather than one person's hours. Records needed.
5	UBALDO SANTIAGO BUONO San Juan, PR, ranked 10108	$996K	Medicaid dollars per patient on code 99233 ($251 per patient-month) sit in the top 5% of every provider billing that code.

All 12 in PR

Recent enforcement in PR

All releases

Department of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.

DOJIndictedJun 23, 2026

2026 National Health Care Fraud Takedown

Four defendants were charged in two schemes, one involving the advertising, sale, and distribution of Semaglutide, Mounjaro, steroids, and Tirzepatide that defendants were not authorized to possess and distribute, and the other involving performing dental procedures on patients without a valid dental license and misbranding of devices.

DOJCivil settlementJun 4, 2026

Puerto Rico Pharmacies Agree to Pay $4.6 Million to Federal Authorities in Medicare and Medicaid Fraud Cases

Four pharmacies and their owners agreed to pay $4.6 million to resolve allegations that between January 2021 and January 2024 they billed Medicare and Medicaid for diverted prescriptions sold to patients that had been misrepresented as properly sourced despite unverifiable origins.

DOJPleaded guiltyJul 17, 2025

Physician Assistant who Pretended to be a Licensed Physician Pleads Guilty to Making False Statements to an Agency of the United States

Villalobos-Meléndez, a licensed physician assistant who was never licensed to practice medicine, forged medical license and USMLE documents, worked as a physician in a hospital internship program, and submitted false license information on a CMS-855I form seeking enrollment as a Medicare physician provider with benefits reassigned to Physician HMO.

DOJCivil settlementDec 23, 2024

MMM Holdings, LLC Agrees to Pay 15.2 Million Dollars to Resolve Allegations that it Violated the False Claims Act and Anti-Kickback Statute

MMM Holdings distributed gift cards to administrative assistants of providers to induce the referral, recommendation, or arrangement for enrollment of thousands of Medicare beneficiaries in an MMM Medicare Advantage plan and submitted or caused claims for payment to Medicare.

DOJIndictedSep 25, 2024

27 Individuals Indicted for Buying and Selling Wholesale Quantities of Misbranded and Diverted Prescription Drugs Resold to the Public Through Retail Pharmacies in Puerto Rico

Defendants engaged in unlicensed wholesale distribution of misbranded and diverted prescription drugs sold to pharmacy owners and employees who resold them to customers and billed health care benefit plans as if the drugs were authentic and obtained through licensed distribution channels.

Referral packet

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