RANDOLPH BIGLANGAWA ROXAS, MD

NPI 1174560072, individual, Tuolumne, CA, Psychiatry & Neurology, Psychiatry

Evidence tier

structure or single-organization volume

Hours beyond a day in 1 month, but with up to 173 patients a month, which points to a supervising clinician on the claims rather than one person's hours.
Records needed.
Medicaid dollars per patient on code 99214 ($230 per patient-month) sit in the top 5% of every provider billing that code.

score 54 of 100, rank 8015, $231K 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 2018	More hours than a day holds at a conservative unit price	3.3	38.3	25.5	34.4	173	1	90833 90836 99213 99214	$78K

National provider registry

From the CMS NPPES Registry, refreshed daily.

Name	RANDOLPH BIGLANGAWA ROXAS, MD
Type	Individual
Status	Active
NPI issued	May 31, 2006, last updated June 19, 2014
Practice location	18880 CHERRY VALLEY BLVD, Tuolumne, CA 95379-9506, 209-928-5400
Specialties	Psychiatry & Neurology, Child & Adolescent Psychiatry (2084P0804X, license A62628 CA) Psychiatry & Neurology, Psychiatry (2084P0800X, primary, license A62628 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
99214	Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	$231K	44%	$230	$60 (top 5% from $133)	99th percentile
T1015	Medicaid service code	$172K	33%	$169	$182 (top 5% from $488)	44th percentile
90833	Psychotherapy with evaluation and management visit, 30 minutes	$84K	16%	$327	$49 (top 5% from $109)	100th percentile
99213	Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more	$34K	6%	$126	$44 (top 5% from $110)	96th percentile
90836	Psychotherapy with evaluation and management visit, 45 minutes	$6K	1%	$427	$72 (top 5% from $190)	too few months to rank
90792	Psychiatric diagnostic evaluation with medical services	$3K	1%	$69	$112 (top 5% from $313)	too few months to rank
90832	Psychotherapy, 30 minutes	$670	0%	$22	$59 (top 5% from $239)	too few months to rank

In this area

11 providers in Tuolumne County, CA carry an indicator in the public record, with $3.9M at stake between them. The most common is more hours than a day holds, on 7 of them, followed by part of a provider network on 3. 1 is tier 1: documented action, then payment.

tier	provider	at stake	why
1	ADULT MEDICINE SPECIALISTS, INC Sonora, CA, ranked 369	$2K	Listed on the Medicare revocation list since July 25, 2018. Medicaid still paid claims in 4 later months, $1,898 in total.
3	WESTERN HEALTH RESOURCES Sonora, CA, ranked 1436	$43K	Part of provider network D1-00071, ranked 71 nationally.
3	SONORA COMMUNITY HOSPITAL Sonora, CA, ranked 3082	$0	Part of provider network D1-00071, ranked 71 nationally.
3	WESTERN HEALTH RESOURCES Sonora, CA, ranked 6493	$0	Part of provider network D1-00071, ranked 71 nationally.
4	ROBERT REINA Sonora, CA, ranked 7656	$2.2M	Hours beyond a day in 20 months, but with up to 542 patients a month, which points to a supervising clinician on the claims rather than one person's hours. Records needed. and 1 more
4	HAKU KAHOANO Jamestown, CA, ranked 8007	$264K	Hours beyond a day in 1 month under one organization, which can be supervisory billing. Records needed. and 1 more
5	RALPH RETHERFORD Sonora, CA, ranked 10327	$359K	Medicaid dollars per patient on code 99214 ($450 per patient-month) sit in the top 5% of every provider billing that code.
5	ALEJANDRO ABARCA Sonora, CA, ranked 10373	$231K	Medicaid dollars per patient on code 90834 ($551 per patient-month) sit in the top 5% of every provider billing that code.

All 11 in CA

Recent enforcement in CA

All releases

Department 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

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