Providers

FRANCO ALEJANDRO VALLEJO GARCIA, MD

NPI 1184031981, individual, Lake Mary, FL, Internal Medicine, Endocrinology, Diabetes & Metabolism

5
Evidence tier
informational
  • Medicaid dollars per patient on code 99306 ($168 per patient-month) sit in the top 5% of every provider billing that code.
score 35 of 100, rank 10132, $897K at stake

National provider registry

From the CMS NPPES Registry, refreshed daily.

NameFRANCO ALEJANDRO VALLEJO GARCIA, MD
TypeIndividual
StatusActive
NPI issuedJuly 14, 2014, last updated July 17, 2025
Practice location525 TECHNOLOGY PARK STE 109, Lake Mary, FL 32746-7107, 407-647-2346
Mailing address8901 CLEMENT AVE, Parkville, MD 21234-2603
Specialties
Internal Medicine, Endocrinology, Diabetes & Metabolism (207RE0101X, primary, license ME171763 FL)
Internal Medicine, Endocrinology, Diabetes & Metabolism (207RE0101X, license 299013-1 NY)

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
codewhat it ispaidshareper patient-monthtypicalrank among providers
99309Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes$461K44%$143$21 (top 5% from $84)98th percentile
99308Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more$298K29%$107$14 (top 5% from $58)99th percentile
99306Initial nursing facility care with high level of medical decision making, per day, if using time, 50 minutes or more$115K11%$168$37 (top 5% from $100)100th percentile
99305Initial nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes$106K10%$129$22 (top 5% from $71)99th percentile
99310Subsequent nursing facility care with high level of medical decision making, per day, if using time, at least 45 minutes$12K1%$176$30 (top 5% from $134)too few months to rank
99214Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more$11K1%$84$60 (top 5% from $133)too few months to rank
99396Medicaid service code$8K1%$92$70 (top 5% from $132)too few months to rank
99202New patient office or other outpatient visit with straightforward medical decision making, if using time, 15 minutes or more$6K1%$75$45 (top 5% from $138)too few months to rank
Medicare Part B 2024, largest codes
codewhat it isservicesbeneficiariespaidsubmitted per serviceallowed per servicecharge to allowedusual for this code
99308Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more691159$41K$115$771.5x2.0x (90th percentile 3.4x)
99309Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes274113$23K$155$1111.4x2.0x (90th percentile 3.3x)
99305Initial nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes184143$20K$225$1371.6x2.0x (90th percentile 3.3x)

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

14 providers in Seminole County, FL carry an indicator in the public record, with $40.6M at stake between them. The most common is more hours than a day holds, on 11 of them, followed by part of a provider network on 3.

tierproviderat stakewhy
3ADVENTHEALTH HOME HEALTH AND HOSPICE INC
Altamonte Springs, FL, ranked 1942
$0
  • Part of provider network D1-00071, ranked 71 nationally.
3ADVENTHEALTH HOME HEALTH AND HOSPICE INC
Altamonte Springs, FL, ranked 2271
$0
  • Part of provider network D1-00071, ranked 71 nationally.
3HOME HEALTH AREA 7, LLC
Altamonte Springs, FL, ranked 6577
$0
  • Part of provider network D1-00053, ranked 53 nationally.
4VENESSA THOMAS
Altamonte Springs, FL, ranked 7318
$1.3M
  • Hours beyond a day in 13 months under one organization, which can be supervisory billing.
  • Records needed.
  • and 2 more
4TIMOTHY HENDRIX
Sanford, FL, ranked 7346
$25.6M
  • Hours beyond a day in 64 months, but with up to 6002 patients a month, which points to a supervising clinician on the claims rather than one person's hours.
  • Records needed.
  • and 1 more
4SCOTT VANLUE
Altamonte Springs, FL, ranked 7406
$7.1M
  • Hours beyond a day in 18 months, but with up to 1939 patients a month, which points to a supervising clinician on the claims rather than one person's hours.
  • Records needed.
  • and 1 more
4PAMELA ROWE
Longwood, FL, ranked 7571
$2.9M
  • Hours beyond a day in 6 months, but with up to 449 patients a month across 3 billing organizations, which points to a supervising clinician on the claims rather than one person's hours.
  • Records needed.
  • and 1 more
5GERMANO FALCAO
Oviedo, FL, ranked 10080
$1.2M
  • Medicaid dollars per patient on code 99204 ($644 per patient-month) sit in the top 5% of every provider billing that code.
All 14 in FL

Recent enforcement in FL

All releases

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

DOJPleaded guiltyAug 14, 2026
Ocala Mental Health Counselor Pleads Guilty to Aggravated Identity Theft and Wire Fraud
Forsythe used the names and insurance policy information of 22 individuals without their consent to bill two health insurance companies for counseling services she had not provided.
DOJConvictedAug 12, 2026
Cuban National Convicted of Unlawfully Obtaining US Citizenship After Concealing Healthcare Fraud Scheme
Rodriguez concealed on her naturalization application her participation in a seven-year healthcare fraud conspiracy that resulted in approximately $4.6 million in fraudulent healthcare claims.
DOJCivil settlementAug 3, 2026
Medicare Advantage Provider Complete Health to Pay $14,100,000 to Settle False Claims Act Suit
Complete Health caused the submission of diagnosis codes within HCC 55 and HCC 59 that were not clinically valid, not supported by medical records, and/or not considered in the beneficiary's care, increasing Medicare Advantage risk-adjusted payments from which it received a percentage.
DOJCivil settlementJul 31, 2026
Two Additional Ophthalmology Practices Agree to Pay $2.3M to Resolve Allegations of Fraudulent Claims to Medicare and Medicaid for Cranial Ultrasounds
Two ophthalmology practices billed Medicare and Medicaid for medically unnecessary trans-cranial doppler ultrasounds premised on false diagnoses, with one practice receiving remuneration from a third-party testing company to refer patients for the tests.
DOJCivil settlementJul 31, 2026
Two Additional Ophthalmology Practices Agree to Pay $2.3M to Resolve Allegations of Fraudulent Claims to Medicare and Medicaid for Cranial Ultrasounds
Two ophthalmology practices billed Medicare and Medicaid for medically unnecessary trans-cranial doppler ultrasounds premised on false diagnoses and, as to Floral Park Ophthalmology, resulting from remuneration paid by a third-party testing company to induce referrals.

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.

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