Providers
MARIECARMEN FONTANET AVILES, OT
NPI 1134289010, individual, Gurabo, PR, Occupational Therapist
5
Evidence tier
informational
- Medicaid dollars per patient on code 97533 ($994 per patient-month) sit in the top 5% of every provider billing that code.
score 36 of 100, rank 9909, $3.6M at stake
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | MARIECARMEN FONTANET AVILES, OT |
| Type | Individual, sole proprietor |
| Status | Active |
| NPI issued | December 11, 2006, last updated October 25, 2018 |
| Practice location | CARR 189 KM 3 HM 6, BARRIO RINCON LOTE #7, Gurabo, PR 00778, 787-744-4824 |
| Mailing address | PMB 2105 P O BOX 4956, Caguas, PR 00726-4956 |
| Specialties | Occupational Therapist (225X00000X, primary, license 476 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 | |
|---|---|---|---|---|---|---|---|
| 97533 | Therapy procedure using sensory experiences | $3.6M | 100% | $994 | $151 (top 5% from $556) | 100th percentile | |
| 97166 | Evaluation for occupational therapy, typically 45 minutes | $7K | 0% | $87 | $53 (top 5% from $238) | too few months to rank | |
| 97129 | Therapy procedure for a range of mental processes, initial 15 minutes | $1K | 0% | $52 | $54 (top 5% from $375) | too few months to rank | |
| 97130 | Therapy procedure for a range of mental processes, each additional 15 minutes | $1K | 0% | $49 | $87 (top 5% from $641) | too few months to rank | |
| 97168 | Re-evaluation for occupational therapy, typically 30 minutes | $684 | 0% | $53 | $43 (top 5% from $127) | too few months to rank | |
| 97112 | Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes | $0 | 0% | $0.00 | $59 (top 5% from $187) | too few months to rank | |
| 97110 | Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes | $0 | 0% | $0.00 | $76 (top 5% from $314) | too few months to rank | |
| 97530 | Therapy procedure using functional activities | $0 | 0% | $0.00 | $124 (top 5% from $387) | too few months to rank |
In this area
2 providers in Gurabo, PR carry an indicator in the public record, with $432K at stake between them. The most common is more hours than a day holds, on 2 of them.
| tier | provider | at stake | why |
|---|---|---|---|
| 5 | IVONNE RODRIGUEZ RAMOS Gurabo, PR, ranked 11404 | $258K | |
| 5 | MELISSA FIGUEROA RESTO Gurabo, PR, ranked 11497 | $173K |
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.