Providers
LOURDES M VALDEZ, M.D.
NPI 1306842265, individual, Rochester, MN, Pediatrics
4
Evidence tier
structure or single-organization volume
- Hours beyond a day in 16 months, but with up to 491 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 99391 ($315 per patient-month) sit in the top 5% of every provider billing that code.
score 55 of 100, rank 7611, $2.6M 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 | 4.3 | 107.9 | 71.9 | 97.0 | 394 | 1 | 99212 99213 99214 | $172K |
| Feb 2018 | More hours than a day holds at a conservative unit price | 4.7 | 118.2 | 78.8 | 110.3 | 386 | 1 | 99212 99213 99214 | $173K |
| Mar 2018 | More hours than a day holds at a conservative unit price | 3.9 | 99.2 | 66.1 | 93.2 | 361 | 1 | 99212 99213 99214 | $162K |
| Apr 2018 | More hours than a day holds at a conservative unit price | 5.8 | 142.3 | 94.8 | 135.5 | 491 | 1 | 99212 99213 99214 | $225K |
| May 2018 | More hours than a day holds at a conservative unit price | 4.7 | 112.3 | 74.8 | 100.9 | 426 | 1 | 99212 99213 99214 | $185K |
| Jun 2018 | More hours than a day holds at a conservative unit price | 3.9 | 92.0 | 61.3 | 87.6 | 347 | 1 | 99212 99213 99214 | $152K |
| Jul 2018 | More hours than a day holds at a conservative unit price | 3.6 | 83.2 | 55.5 | 78.2 | 344 | 1 | 99212 99213 99214 | $146K |
| Aug 2018 | More hours than a day holds at a conservative unit price | 3.9 | 94.2 | 62.8 | 84.6 | 377 | 1 | 99212 99213 99214 | $165K |
| Sep 2018 | More hours than a day holds at a conservative unit price | 3.9 | 94.8 | 63.2 | 94.8 | 360 | 1 | 99212 99213 99214 | $156K |
| Oct 2018 | More hours than a day holds at a conservative unit price | 3.6 | 77.4 | 51.6 | 69.6 | 378 | 1 | 99212 99213 99214 | $141K |
| Dec 2018 | More hours than a day holds at a conservative unit price | 2.1 | 45.5 | 30.3 | 44.8 | 205 | 1 | 99212 99213 99214 | $76K |
| Jan 2019 | More hours than a day holds at a conservative unit price | 2.4 | 78.5 | 52.3 | 70.5 | 228 | 1 | 99212 99213 99214 | $98K |
| Feb 2019 | More hours than a day holds at a conservative unit price | 4.7 | 156.1 | 104.1 | 145.7 | 382 | 1 | 99212 99213 99214 | $175K |
| Mar 2019 | More hours than a day holds at a conservative unit price | 5.4 | 182.7 | 121.8 | 179.8 | 463 | 1 | 99212 99213 99214 | $227K |
| Apr 2019 | More hours than a day holds at a conservative unit price | 4.9 | 162.2 | 108.1 | 147.5 | 407 | 1 | 99212 99213 99214 | $194K |
| May 2019 | More hours than a day holds at a conservative unit price | 2.5 | 77.6 | 51.7 | 69.7 | 233 | 1 | 99212 99213 99214 | $97K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | LOURDES M VALDEZ, M.D. |
| Type | Individual |
| Status | Active |
| NPI issued | June 24, 2005, last updated October 5, 2023 |
| Practice location | 200 1ST ST SW, Rochester, MN 55905-0001, 507-284-2511 |
| Specialties | Pediatrics (208000000X, license A62728 CA) Pediatrics (208000000X, primary, license 74389 MN) |
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 | |
|---|---|---|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | $1.8M | 30% | $315 | $44 (top 5% from $110) | 99th percentile | |
| T1015 | Medicaid service code | $1.5M | 25% | $481 | $182 (top 5% from $488) | 95th percentile | |
| 99212 | Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more | $589K | 10% | $303 | $28 (top 5% from $147) | 98th percentile | |
| 99391 | Medicaid service code | $547K | 9% | $268 | $76 (top 5% from $126) | 100th percentile | |
| 99392 | Medicaid service code | $489K | 8% | $251 | $78 (top 5% from $124) | 100th percentile | |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $227K | 4% | $327 | $60 (top 5% from $133) | 100th percentile | |
| 99393 | Medicaid service code | $170K | 3% | $282 | $78 (top 5% from $121) | 100th percentile | |
| 90670 | Pneumococcal vaccine, 13-valent | $92K | 2% | $59 | $0.54 (top 5% from $23) | 99th percentile |
In this area
4 providers in Olmsted County, MN carry an indicator in the public record, with $607K at stake between them. The most common is part of a provider network, on 2 of them, followed by paid after a public list action on 1. 1 is tier 1: documented action, then payment.
| tier | provider | at stake | why |
|---|---|---|---|
| 1 | HIGHLAND MEADOWS COUNSELING CENTER, INC. Rochester, MN, ranked 126 | $138K |
|
| 3 | MAYO CLINIC Rochester, MN, ranked 1840 | $0 |
|
| 3 | CHARTERHOUSE INC Rochester, MN, ranked 5957 | $0 |
|
| 5 | BRITTANY VEGA Rochester, MN, ranked 11233 | $468K |
Recent enforcement in MN
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
DOJOtherMay 22, 2026
This Week in Fraud: The Fraud Division Announced Expansion of Midwest Task Force and Authorization to Hire 15 New Medicaid Prosecutors, an Unprecedented Minnesota Health Care Fraud Takedown, and a $2 Billion Telemedicine Health Care Fraud Scheme
The Justice Department announced charges against 15 defendants for Medicaid fraud schemes totaling over $90 million in intended loss, a 10-year sentence in a $2 billion international health care fraud conspiracy in Brooklyn, and a Michigan jury conviction of a nurse who bribed a Detroit hospital nurse for confidential records used to bill Medicare in a $1.6 million scheme, along with expansion of the Health Care Fraud Midwest Strike Force and hiring of 15 additional Medicaid fraud prosecutors.
DOJChargedMay 21, 2026
Minnesota Health Care Fraud Takedown Results in Charges Against 15 Defendants for Over $90M in Fraud
Fifteen defendants were charged in connection with schemes involving over $90 million in intended loss against Minnesota Medicaid programs, including paying kickbacks to parents and billing for autism, Integrated Community Supports, Individualized Home Supports, Housing Stabilization Services and child care services that were not provided as represented.
DOJPleaded guiltyFeb 10, 2026
Fraud Tourists Plead Guilty to Minneapolis Medicaid Fraud
Two men set up businesses in Minneapolis, enrolled as Housing Stabilization Services providers, recruited Medicaid beneficiaries at homeless shelters and Section 8 housing, billed for services not provided, and used ChatGPT and fabricated e-mails to create fake client records when asked for documentation.
DOJChargedSep 24, 2025
First Defendant Charged in Autism Fraud Scheme
Hassan and others enrolled Smart Therapy LLC as an EIDBI autism services provider, recruited children with cash kickbacks to parents, employed unqualified behavioral technicians, and submitted inflated and fabricated Medicaid claims for services not provided, obtaining more than $14 million, while also submitting approximately $465,000 in fraudulent Federal Child Nutrition Program claims through Feeding Our Future.
DOJCivil settlementJun 26, 2025
NUWAY Alliance Agrees to Pay $18,500,000 Settlement in Medicaid Kickbacks Scheme, False Claims Act Violations
NUWAY compensated Medicaid patients for seeking intensive outpatient treatment in violation of the federal anti-kickback statute and submitted false claims for IOP services not provided by double-billing the same period of time as distinct billable units.
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.