Providers
All 12 in PR
UBALDO G SANTIAGO BUONO, M.D.
NPI 1104825611, individual, San Juan, PR, Internal Medicine, Geriatric Medicine
5
Evidence tier
informational
- Medicaid dollars per patient on code 99233 ($251 per patient-month) sit in the top 5% of every provider billing that code.
score 35 of 100, rank 10108, $996K 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 |
|---|---|---|---|---|---|---|---|---|---|
| Jan 2023 | More hours than a day holds, even counting one unit per claim line | 27.1 | 27.6 | 18.4 | 25.9 | 149 | 1 | 99223 99233 99238 | $85K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | UBALDO G SANTIAGO BUONO, M.D. |
| Type | Individual, sole proprietor |
| Status | Active |
| NPI issued | July 18, 2005, last updated June 10, 2024 |
| Practice location | 1304 WILSON STREET, COND EL VIGIA APT 8 S, San Juan, PR 00907-2243, 787-536-2033 |
| Mailing address | 1304 CALLE WILSON APT 8S, San Juan, PR 00907-2243 |
| Specialties | Internal Medicine, Geriatric Medicine (207RG0300X, primary, license 13571 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 | |
|---|---|---|---|---|---|---|---|
| 99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | $2.6M | 80% | $251 | $96 (top 5% from $249) | 95th percentile | |
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | $301K | 9% | $66 | $81 (top 5% from $170) | 34th percentile | |
| 99238 | Hospital discharge day management, 30 minutes or less | $262K | 8% | $42 | $48 (top 5% from $80) | 41st percentile | |
| 99283 | Emergency department visit with low level of medical decision making | $36K | 1% | $14 | $60 (top 5% from $193) | 2nd percentile | |
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | $9K | 0% | $114 | $67 (top 5% from $174) | too few months to rank | |
| 99285 | Emergency department visit with high level of medical decision making | $7K | 0% | $135 | $100 (top 5% from $264) | too few months to rank | |
| 99243 | Medicaid service code | $4K | 0% | $37 | $87 (top 5% from $148) | 10th percentile | |
| 99222 | Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes | $2K | 0% | $102 | $63 (top 5% from $137) | too few months to rank |
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 |
|---|---|---|---|---|---|---|---|---|
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | 144 | 16 | $9K | $116 | $77 | 1.5x | 2.6x (90th percentile 4.3x) |
| 99221 | Initial hospital care with straightforward or low level of medical decision making, per day, if using time, at least 40 minutes | 16 | 16 | $1K | $169 | $81 | 2.1x | 3.1x (90th percentile 5.2x) |
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
12 providers in San Juan Municipio County, PR carry an indicator in the public record, with $4.2M 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 |
|
| 1 | PHYSICIAN HMO INC. San Juan, PR, ranked 408 | $680 |
|
| 1 | PHYSICIAN HMO INC. Rio Piedras, PR, ranked 460 | $0 |
|
| 3 | CMS HOME CARE METRO, LLC. San Juan, PR, ranked 5251 | $0 |
|
| 4 | FRANKIE ALVARADO San Juan, PR, ranked 7831 | $1.0M |
|
| 4 | JAN RODRIGUEZ FERRER San Juan, PR, ranked 7946 | $483K |
|
| 4 | ARNALDO CRUZ IGARTUA San Juan, PR, ranked 8890 | $1.3M |
|
| 4 | WALESKA LIND San Juan, PR, ranked 9521 | $144K |
|
Recent enforcement in PR
All releasesDepartment 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
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.