ALYSE NANETTA MUNOZ, EdD, LCSW

NPI 1063923167, individual, Triangle, VA, Social Worker, Clinical

Evidence tier

informational

96% of Medicaid dollars are on codes with a history of abuse.

score 32 of 100, rank 10635, $206K at stake

National provider registry

From the CMS NPPES Registry, refreshed daily.

Name	ALYSE NANETTA MUNOZ, EdD, LCSW
Type	Individual, sole proprietor
Status	Active
NPI issued	October 16, 2017, last updated May 21, 2025
Practice location	18313 CANDICE DR, Triangle, VA 22172-1413, 720-289-9116
Specialties	Social Worker, Clinical (1041C0700X, primary, license CSW.09924557 CO)

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
90837	Psychotherapy, 1 hourhistory of abuse	$531K	96%	$405	$191 (top 5% from $442)	94th percentile
90791	Psychiatric diagnostic evaluation	$14K	2%	$195	$105 (top 5% from $228)	too few months to rank
T1017	Targeted case management each 15 min	$7K	1%	$69	$167 (top 5% from $808)	29th percentile
H0002	Medicaid service code	$1K	0%	$34	$34 (top 5% from $215)	too few months to rank

In this area

5 providers in Prince William County, VA carry an indicator in the public record, with $6.9M at stake between them. The most common is part of a provider network, on 2 of them, followed by paid after a public list action on 1. 2 are tier 1: documented action, then payment.

tier	provider	at stake	why
1	KAREN HOBBS Woodbridge, VA, ranked 281	$11K	Listed on the CA Medicaid exclusion list since December 30, 2017. Medicaid still paid claims in 5 later months, $10,631 in total.
1	KYNETIC MEDICAL GROUP INC Woodbridge, VA, ranked 482	$0	Adjudicated (sentenced) per a Department of Justice release dated May 23, 2025. No Medicaid payments in the last 12 observed months.
3	HERITAGE HUNT LLC Gainesville, VA, ranked 3269	$0	Part of provider network D1-00136, ranked 136 nationally.
3	MANASSAS HEALTH CARE LLC Manassas, VA, ranked 4147	$0	Part of provider network D1-00136, ranked 136 nationally.
4	KRISHNA MADIRAJU Woodbridge, VA, ranked 8345	$6.9M	Hours beyond a day in 8 months, but with up to 1744 patients a month, which points to a supervising clinician on the claims rather than one person's hours. Records needed.

Recent enforcement in VA

All releases

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

DOJChargedJun 23, 2026

U.S. Attorney’s Office announces charges against three defendants in the Eastern District of Virginia as part of national health care fraud takedown

Three defendants were charged with fraudulently billing Medicaid for mental health services that were not provided and with submitting false claims to Medicare through a straw-owned durable medical equipment company.

DOJSentencedJun 5, 2026

Medicaid service providers sentenced for false statements resulting in overbilling

Wright and Winfield instructed CCR employees to falsely claim in progress notes that children received therapeutic day treatment services from 2:00pm to 7:00pm, including providing prefilled progress note templates, resulting in overbilling to Medicaid.

DOJCivil settlementApr 27, 2026

Tri-Area Community Health Agrees to Pay $513,000 to Resolve Medicare Billing Allegations

Tri-Area Community Health billed Medicare for Annual Wellness Visits provided by pharmacists without appropriate physician supervision that were billed under the names of physicians not involved with the visits.

DOJSentencedMar 17, 2026

Six Sentenced in Healthcare Fraud Conspiracy that Stole $10 Million from Medicaid Over Six-Year Period

Six defendants conspired to submit false claims to Virginia Medicaid on behalf of 1st Adult N Pediatric Healthcare Services for nursing and personal care services that were not provided, including falsifying records and paying parents or guardians of patients for blank, signed nursing notes.

DOJIndictedMar 11, 2026

Victim Advisory- Divine Youth Case Updates

Divine Youth Counseling submitted more than $11 million in fraudulent Medicaid claims for Crisis Stabilization and Mobile Crisis services by falsely claiming two mental health professionals provided Team Treatment services and paid more than $470,000 in kickbacks in the form of hotel rooms for Medicaid recipients.

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.

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