Providers
All 12 in CA
JORGE LOPEZ-AGUADO, M.D/
NPI 1104935329, individual, Oakhurst, CA, Pediatrics
4
Evidence tier
structure or single-organization volume
- Hours beyond a day in 2 months, but with up to 958 patients a month across 3 billing organizations, which points to a supervising clinician on the claims rather than one person's hours.
- Records needed.
score 51 of 100, rank 9142, $613K 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 |
|---|---|---|---|---|---|---|---|---|---|
| Apr 2024 | More hours than a day holds at a conservative unit price | 10.5 | 40.8 | 27.2 | 37.1 | 652 | 2 | 99213 | $33K |
| May 2024 | More hours than a day holds at a conservative unit price | 9.1 | 36.3 | 24.2 | 32.6 | 679 | 2 | 99213 | $31K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | JORGE LOPEZ-AGUADO, M.D/ |
| Type | Individual, sole proprietor |
| Status | Active |
| NPI issued | August 30, 2006, last updated September 9, 2011 |
| Practice location | 49430 ROAD 426, SUITE B, Oakhurst, CA 93644-8618, 559-683-2459 |
| Mailing address | PO BOX 2588, Oakhurst, CA 93644-2588 |
| Specialties | Pediatrics (208000000X, primary, license F39744 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 | $4.9M | 75% | $118 | $182 (top 5% from $488) | 27th percentile | |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | $910K | 14% | $23 | $44 (top 5% from $110) | 19th percentile | |
| 99393 | Medicaid service code | $153K | 2% | $34 | $78 (top 5% from $121) | 19th percentile | |
| 99392 | Medicaid service code | $142K | 2% | $30 | $78 (top 5% from $124) | 16th percentile | |
| 99394 | Medicaid service code | $137K | 2% | $42 | $83 (top 5% from $128) | 22nd percentile | |
| 99391 | Medicaid service code | $80K | 1% | $24 | $76 (top 5% from $126) | 11th percentile | |
| 92551 | Medicaid service code | $58K | 1% | $6.62 | $4.76 (top 5% from $18) | 59th percentile | |
| 99173 | Medicaid service code | $28K | 0% | $3.25 | $1.22 (top 5% from $11) | 77th percentile |
In this area
12 providers in Madera County, CA carry an indicator in the public record, with $5.4M at stake between them. The most common is more hours than a day holds, on 9 of them, followed by part of a provider network on 2. 1 is tier 1: documented action, then payment.
| tier | provider | at stake | why |
|---|---|---|---|
| 1 | TODD SPENCER Madera, CA, ranked 389 | $1K |
|
| 3 | OAKHURST SKILLED CARE LLC Oakhurst, CA, ranked 2560 | $0 |
|
| 3 | PALMS CARE CENTER LLC Chowchilla, CA, ranked 5218 | $0 |
|
| 4 | QIU ZHONG Madera, CA, ranked 7890 | $733K |
|
| 4 | ESEQUIEL RODRIGUEZ Madera, CA, ranked 7955 | $445K |
|
| 4 | MARK ROWE Madera, CA, ranked 8003 | $275K |
|
| 4 | NAEEM SIDDIQI Madera, CA, ranked 8576 | $2.9M |
|
| 4 | ROSALBA SERRANO RIVERA Madera, CA, ranked 9103 | $694K |
|
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.