Providers
DIANA M. GALLARDO, DMD
NPI 1346460094, individual, Caguas, PR, Dentist
1
Evidence tier
documented action, then payment
- Listed on the OIG exclusion list and the Medicare revocation list since July 9, 2021.
- Medicaid still paid claims in 8 later months, $5,215 in total.
score 94 of 100, rank 321, $5K at stake
Public list actions
Medicare revocation effective July 9, 2021, barred from re-enrolling until July 9, 2031
424.535(a)(9) failure to report and 424.535(a)(3) felonies and 424.535(a)(2) provider or supplier conduct (exclusion), Order And Referring Only - Dentist, PR
OIG exclusion July 20, 2022 under section 1128a1
Ind- Lic HC Serv Pro, Dentist, Caguas, PR
Paid after the action
Months in which Medicaid paid claims for this provider after a public action that should have triggered a screening check. This is a record of payments, not a determination that they were improper.
| list | identity check | action date | window closed | months paid after | first | last | paid after | 12 months before |
|---|---|---|---|---|---|---|---|---|
| Medicare revocation list 424.535(a)(9) failure to report and 424.535(a)(3) felonies and 424.535(a)(2) provider or supplier conduct (exclusion) | Exact NPI, name verified | Jul 9, 2021 | Jul 9, 2031 | 8 | Sep 2021 | Sep 2022 | $5K | $11K |
| OIG exclusion list leie 1128a1 (ind- lic hc serv pro) | Exact NPI, name verified | Jul 20, 2022 | still open | 1 | Sep 2022 | Sep 2022 | $203 | $5K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | DIANA M. GALLARDO, DMD |
| Type | Individual |
| Status | Active |
| NPI issued | April 26, 2007, last updated July 8, 2007 |
| Practice location | CARR 156 KM .59.6, CALLE BETANCES FINAL EDIF PUIG SUITE #2, Caguas, PR 00725, 787-744-0600 |
| Mailing address | PO BOX 9508, Caguas, PR 00726-9508 |
| Specialties | Dentist (122300000X, primary, license 1859 PR) |
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 | |
|---|---|---|---|---|---|---|---|
| D1999 | Medicaid service code | $10K | 49% | $20 | $4.52 (top 5% from $21) | 94th percentile | |
| D1110 | Medicaid service code | $6K | 28% | $29 | $45 (top 5% from $86) | 16th percentile | |
| D0150 | Medicaid service code | $2K | 8% | $27 | $35 (top 5% from $66) | too few months to rank | |
| D0272 | Medicaid service code | $1K | 7% | $17 | $17 (top 5% from $30) | 48th percentile | |
| D0330 | Panoramic radiographic image | $1K | 6% | $46 | $40 (top 5% from $76) | too few months to rank | |
| D0120 | Medicaid service code | $369 | 2% | $15 | $26 (top 5% from $63) | too few months to rank |
In this area
7 providers in Caguas Municipio County, PR carry an indicator in the public record, with $8.5M at stake between them. The most common is more hours than a day holds, on 7 of them.
| tier | provider | at stake | why |
|---|---|---|---|
| 2 | YAMIR GARCIA SEGARRA Caguas, PR, ranked 696 | $1.9M |
|
| 4 | FRANCISCO ALVARADO MELENDEZ Caguas, PR, ranked 8033 | $198K |
|
| 4 | NYDIA GONZALEZ LOPEZ Caguas, PR, ranked 8408 | $5.1M |
|
| 5 | LUIS JIMENEZ REYES Caguas, PR, ranked 10147 | $809K |
|
| 5 | ALWIN VARGAS Caguas, PR, ranked 10350 | $279K |
|
| 5 | LEONARDO PIRILLO Caguas, PR, ranked 10460 | $94K |
|
| 5 | IVELISSE LOPEZ Caguas, PR, ranked 11650 | $90K |
Recent enforcement in PR
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
DOJIndictedJun 23, 2026
2026 National Health Care Fraud Takedown
Four defendants were charged in two schemes, one involving the advertising, sale, and distribution of Semaglutide, Mounjaro, steroids, and Tirzepatide that defendants were not authorized to possess and distribute, and the other involving performing dental procedures on patients without a valid dental license and misbranding of devices.
DOJCivil settlementJun 4, 2026
Puerto Rico Pharmacies Agree to Pay $4.6 Million to Federal Authorities in Medicare and Medicaid Fraud Cases
Four pharmacies and their owners agreed to pay $4.6 million to resolve allegations that between January 2021 and January 2024 they billed Medicare and Medicaid for diverted prescriptions sold to patients that had been misrepresented as properly sourced despite unverifiable origins.
DOJPleaded guiltyJul 17, 2025
Physician Assistant who Pretended to be a Licensed Physician Pleads Guilty to Making False Statements to an Agency of the United States
Villalobos-Meléndez, a licensed physician assistant who was never licensed to practice medicine, forged medical license and USMLE documents, worked as a physician in a hospital internship program, and submitted false license information on a CMS-855I form seeking enrollment as a Medicare physician provider with benefits reassigned to Physician HMO.
DOJCivil settlementDec 23, 2024
MMM Holdings, LLC Agrees to Pay 15.2 Million Dollars to Resolve Allegations that it Violated the False Claims Act and Anti-Kickback Statute
MMM Holdings distributed gift cards to administrative assistants of providers to induce the referral, recommendation, or arrangement for enrollment of thousands of Medicare beneficiaries in an MMM Medicare Advantage plan and submitted or caused claims for payment to Medicare.
DOJIndictedSep 25, 2024
27 Individuals Indicted for Buying and Selling Wholesale Quantities of Misbranded and Diverted Prescription Drugs Resold to the Public Through Retail Pharmacies in Puerto Rico
Defendants engaged in unlicensed wholesale distribution of misbranded and diverted prescription drugs sold to pharmacy owners and employees who resold them to customers and billed health care benefit plans as if the drugs were authentic and obtained through licensed distribution channels.
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.