ROBERTO RUIZ, LCSW

NPI 1134337652, individual, Las Vegas, NV, Social Worker, Clinical

Evidence tier

impossible volume with concurrency

Billed more hands-on hours than a day holds in 4 months, peaking at 44.4 hours per day across 3 billing organizations.
Medicaid dollars per patient on code 90901 ($683 per patient-month) sit in the top 5% of every provider billing that code.

score 85 of 100, rank 699, $1.2M 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
Feb 2021	More hours than a day holds, even counting one unit per claim line	41.0	42.3	28.2	39.5	310	1	90791 90832 90837 90876	$133K
Jun 2022	More hours than a day holds, even counting one unit per claim line	63.7	66.6	44.4	60.6	255	2	90837 90876	$236K
Jul 2022	More hours than a day holds, even counting one unit per claim line	46.4	46.1	30.8	45.4	260	2	90791 90837 90876	$169K
Aug 2022	More hours than a day holds, even counting one unit per claim line	24.3	24.0	16.0	21.6	213	2	90791 90837 90876	$87K

National provider registry

From the CMS NPPES Registry, refreshed daily.

Name	ROBERTO RUIZ, LCSW
Type	Individual, sole proprietor
Status	Active
NPI issued	May 18, 2007, last updated December 1, 2016
Practice location	2725 BYRON DR, Las Vegas, NV 89134-7583, 702-321-9103
Specialties	Social Worker, Clinical (1041C0700X, primary, license 00339C NV)

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
90876	Psychophysiological therapy with biofeedback 45 min	$1.2M	55%	$788	$392 (top 5% from $816)	93rd percentile
90901	Biofeedback training	$381K	17%	$683	$45 (top 5% from $503)	100th percentile
90837	Psychotherapy, 1 hourhistory of abuse	$308K	14%	$95	$191 (top 5% from $442)	12th percentile
Q3014	Telehealth originating site facility fee	$126K	6%	$41	$21 (top 5% from $84)	85th percentile
90791	Psychiatric diagnostic evaluation	$94K	4%	$94	$105 (top 5% from $228)	40th percentile
H0031	Medicaid service code	$33K	2%	$170	$100 (top 5% from $540)	too few months to rank
90832	Psychotherapy, 30 minutes	$19K	1%	$30	$59 (top 5% from $239)	26th percentile
H0002	Medicaid service code	$10K	0%	$22	$34 (top 5% from $215)	26th percentile

In this area

338 providers in Clark County, NV carry an indicator in the public record, with $275.1M at stake between them. The most common is part of a provider network, on 167 of them, followed by more hours than a day holds on 151. 17 are tier 1: documented action, then payment.

tier	provider	at stake	why
1	TIMOTHY WILSON Las Vegas, NV, ranked 113	$192K	Listed on the Medicare revocation list since January 26, 2023. Medicaid still paid claims in 21 later months, $191,872 in total.
1	DEVONTE' CHRISTOPHER North Las Vegas, NV, ranked 175	$59K	Listed on the AZ Medicaid exclusion list since September 1, 2024. Medicaid still paid claims in 1 later month, $59,101 in total.
1	MANE SHAH Las Vegas, NV, ranked 205	$40K	Listed on the Medicare revocation list since August 16, 2018. Medicaid still paid claims in 15 later months, $40,126 in total.
1	JOHN MARIUS TOLENTINO Las Vegas, NV, ranked 254	$16K	Listed on the CA Medicaid exclusion list since December 2, 2022. Medicaid still paid claims in 5 later months, $16,415 in total.
1	DAVID ADAMS Las Vegas, NV, ranked 345	$3K	Listed on the CA Medicaid exclusion list since October 2, 2018. Medicaid still paid claims in 2 later months, $3,216 in total.
1	VICTOR BRUCE Las Vegas, NV, ranked 361	$2K	Listed on the OIG exclusion list and the NY Medicaid exclusion list and the SAM.gov exclusion list (OPM) since December 20, 2015. Medicaid still paid claims in 2 later months, $2,266 in total.
1	AMARA MEDICAL CENTER LLC Las Vegas, NV, ranked 457	$9	Listed on the Medicare revocation list since June 20, 2024. Medicaid still paid claims in 2 later months, $9 in total.
1	RODNESHIA CARTER North Las Vegas, NV, ranked 479	$0	Adjudicated (sentenced) per a state attorney general release dated December 9, 2024. No Medicaid payments in the last 12 observed months.

All 338 in NV

Recent enforcement in NV

All releases

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

DOJIndictedSep 24, 2025

Reno Doctor Arrested And Indicted For Health Care Fraud

An OB-GYN allegedly submitted false claims to Medicaid and private health plans for gynecologic tests and surgical procedures that were not medically necessary and falsified patients' medical records.

DOJPleaded guiltyJul 16, 2025

Nevada Nurse Practitioner Pleads Guilty To Fraudulent Medicare Wound Care Billing

A nurse practitioner admitted conspiring to fraudulently bill Medicare approximately $14,333,550 for amniotic wound allografts that were medically unnecessary and were procured through illegal kickbacks and bribes.

DOJChargedJun 30, 2025

U.S. Attorney's Office Participates In Record-Setting National Health Care Fraud Takedown

Two Las Vegas nurses were charged by information with conspiracy to defraud the United States and to pay and receive kickbacks for applying medically unnecessary amniotic wound allografts to Medicare beneficiaries and receiving kickbacks, with wound care companies billing Medicare over $94 million and approximately $14.3 million respectively.

DOJSentencedMay 1, 2024

Las Vegas Woman Sentenced To Prison For $1 Million Medicaid Fraud Scheme

Binford failed to disclose her criminal history to enroll her company Shepherd's Heart Services as a Nevada Medicaid provider and then submitted false bills for counseling services and training not rendered.

Referral packet

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