Providers
All 11 in CA
ROBERT I. REINA, M.D.
NPI 1295739845, individual, Sonora, CA, Family Medicine
4
Evidence tier
structure or single-organization volume
- 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.
- Medicaid dollars per patient on code 99214 ($668 per patient-month) sit in the top 5% of every provider billing that code.
score 55 of 100, rank 7656, $2.2M 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 |
|---|---|---|---|---|---|---|---|---|---|
| Jan 2018 | More hours than a day holds at a conservative unit price | 8.2 | 125.9 | 83.9 | 113.1 | 542 | 1 | 99203 99211 99212 99213 99214 | $230K |
| Feb 2018 | More hours than a day holds at a conservative unit price | 8.1 | 129.6 | 86.4 | 120.9 | 469 | 1 | 99212 99213 99214 | $207K |
| Mar 2018 | More hours than a day holds at a conservative unit price | 7.7 | 121.9 | 81.2 | 114.5 | 466 | 1 | 99203 99212 99213 99214 | $218K |
| Apr 2018 | More hours than a day holds at a conservative unit price | 3.9 | 62.1 | 41.4 | 59.1 | 239 | 1 | 99213 99214 | $104K |
| May 2018 | More hours than a day holds at a conservative unit price | 4.4 | 70.9 | 47.3 | 63.7 | 268 | 1 | 99203 99213 99214 | $123K |
| Jun 2018 | More hours than a day holds at a conservative unit price | 4.0 | 67.1 | 44.7 | 63.9 | 230 | 1 | 99213 99214 | $112K |
| Jul 2018 | More hours than a day holds at a conservative unit price | 3.3 | 56.7 | 37.8 | 53.2 | 201 | 1 | 99213 99214 | $96K |
| Aug 2018 | More hours than a day holds at a conservative unit price | 4.4 | 76.3 | 50.9 | 68.6 | 256 | 1 | 99213 99214 | $129K |
| Sep 2018 | More hours than a day holds at a conservative unit price | 3.4 | 58.6 | 39.0 | 58.6 | 215 | 1 | 99213 99214 | $96K |
| Oct 2018 | More hours than a day holds at a conservative unit price | 3.8 | 62.5 | 41.7 | 56.2 | 231 | 1 | 99213 99214 | $107K |
| Nov 2018 | More hours than a day holds at a conservative unit price | 3.9 | 63.6 | 42.4 | 57.8 | 234 | 1 | 99213 99214 | $107K |
| Dec 2018 | More hours than a day holds at a conservative unit price | 3.5 | 56.8 | 37.9 | 55.9 | 215 | 1 | 99213 99214 | $99K |
| Jan 2019 | More hours than a day holds at a conservative unit price | 4.1 | 83.3 | 55.5 | 74.8 | 249 | 1 | 99213 99214 | $129K |
| Feb 2019 | More hours than a day holds at a conservative unit price | 3.2 | 64.2 | 42.8 | 59.9 | 188 | 1 | 99213 99214 | $91K |
| Mar 2019 | More hours than a day holds at a conservative unit price | 2.3 | 50.3 | 33.5 | 49.5 | 149 | 1 | 99213 99214 | $74K |
| Apr 2019 | More hours than a day holds at a conservative unit price | 2.2 | 49.4 | 33.0 | 45.0 | 143 | 1 | 99213 99214 | $70K |
| May 2019 | More hours than a day holds at a conservative unit price | 2.3 | 47.3 | 31.5 | 42.5 | 153 | 1 | 99213 99214 | $71K |
| Jun 2019 | More hours than a day holds at a conservative unit price | 1.9 | 40.0 | 26.7 | 40.0 | 129 | 1 | 99213 99214 | $57K |
| Jul 2019 | More hours than a day holds at a conservative unit price | 2.1 | 45.1 | 30.1 | 40.5 | 140 | 1 | 99213 99214 | $66K |
| Aug 2019 | More hours than a day holds at a conservative unit price | 1.9 | 42.5 | 28.3 | 39.9 | 134 | 1 | 99213 99214 | $60K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | ROBERT I. REINA, M.D. |
| Type | Individual |
| Status | Active |
| NPI issued | June 10, 2005, last updated February 3, 2022 |
| Practice location | 13975 MONO WAY STE G, Sonora, CA 95370-2824, 209-533-9600 |
| Mailing address | PO BOX 939, Angels Camp, CA 95222-0939 |
| Specialties | Internal Medicine (207R00000X, license A54907 CA) Family Medicine (207Q00000X, primary, license A54907 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 | $1.5M | 38% | $459 | $60 (top 5% from $133) | 100th percentile | |
| T1015 | Medicaid service code | $1.4M | 37% | $668 | $182 (top 5% from $488) | 97th percentile | |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | $750K | 19% | $447 | $44 (top 5% from $110) | 100th percentile | |
| 99396 | Medicaid service code | $70K | 2% | $419 | $70 (top 5% from $132) | 100th percentile | |
| 99212 | Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more | $26K | 1% | $431 | $28 (top 5% from $147) | too few months to rank | |
| 96372 | Injection of drug or substance under skin or into muscle | $21K | 1% | $92 | $12 (top 5% from $49) | 98th percentile | |
| 99203 | New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more | $18K | 0% | $405 | $67 (top 5% from $121) | too few months to rank | |
| 0002A | Intramuscular administration of single severe acute respiratory syndrome coronavirus 2 (covid-19) vaccine, mrna-lnp, spike protein, preservative free, 30 mcg/0.3ml dosage, diluent reconstituted; second dose | $17K | 0% | $35 | $38 (top 5% from $67) | 30th percentile |
Medicare Part B 2024, largest codes
| code | what it is | services | beneficiaries | paid | submitted per service | allowed per service | charge to allowed | usual for this code |
|---|---|---|---|---|---|---|---|---|
| 99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | 93 | 59 | $9K | $607 | $116 | 5.2x | 2.6x (90th percentile 4.7x) |
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | 113 | 48 | $7K | $200 | $75 | 2.7x | 2.6x (90th percentile 4.3x) |
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | 48 | 43 | $6K | $632 | $165 | 3.8x | 3.0x (90th percentile 5.6x) |
| 99291 | Critical care, first 30-74 minutes | 38 | 14 | $6K | $831 | $200 | 4.2x | 4.7x (90th percentile 10.0x) |
| 99239 | Hospital discharge day management, more than 30 minutes | 67 | 56 | $6K | $373 | $110 | 3.4x | 2.8x (90th percentile 5.6x) |
| 83036 | Hemoglobin a1c level | 71 | 56 | $676 | $26 | $10 | 2.7x | 3.5x (90th percentile 6.9x) |
| 80061 | Blood test, lipids (cholesterol and triglycerides) | 21 | 18 | $276 | $35 | $13 | 2.7x | 3.5x (90th percentile 6.9x) |
| 81002 | Urinalysis, manual test | 44 | 35 | $150 | $5 | $3 | 1.5x | 3.5x (90th percentile 7.6x) |
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
11 providers in Tuolumne County, CA carry an indicator in the public record, with $1.9M 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 |
|
| 3 | WESTERN HEALTH RESOURCES Sonora, CA, ranked 1436 | $43K |
|
| 3 | SONORA COMMUNITY HOSPITAL Sonora, CA, ranked 3082 | $0 |
|
| 3 | WESTERN HEALTH RESOURCES Sonora, CA, ranked 6493 | $0 |
|
| 4 | HAKU KAHOANO Jamestown, CA, ranked 8007 | $264K |
|
| 4 | RANDOLPH ROXAS Tuolumne, CA, ranked 8015 | $231K |
|
| 5 | RALPH RETHERFORD Sonora, CA, ranked 10327 | $359K |
|
| 5 | ALEJANDRO ABARCA Sonora, CA, ranked 10373 | $231K |
|
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.