Providers
All 35 in RI
PAUL CASTALDI, LICSW
NPI 1376829127, individual, Bristol, RI, Social Worker, Clinical
4
Evidence tier
structure or single-organization volume
- Hours beyond a day in 34 months under one organization, which can be supervisory billing.
- Records needed.
- Medicaid dollars per patient on code H0004 ($880 per patient-month) sit in the top 5% of every provider billing that code.
- 98% of Medicaid dollars are on codes with a history of abuse.
score 58 of 100, rank 7287, $5.2M 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 |
|---|---|---|---|---|---|---|---|---|---|
| May 2020 | More hours than a day holds at a conservative unit price | 15.4 | 91.9 | 61.3 | 79.9 | 303 | 1 | 90791 H0004 H2014 | $155K |
| Jun 2020 | More hours than a day holds at a conservative unit price | 15.0 | 93.7 | 62.5 | 77.9 | 284 | 1 | 90791 H0004 H2014 | $149K |
| Jul 2020 | More hours than a day holds at a conservative unit price | 15.1 | 112.0 | 74.6 | 93.6 | 295 | 1 | 90791 H0004 H2014 | $181K |
| Aug 2020 | More hours than a day holds at a conservative unit price | 10.7 | 82.8 | 55.2 | 75.6 | 259 | 1 | 90791 H0004 H2014 | $134K |
| Oct 2020 | More hours than a day holds at a conservative unit price | 14.1 | 105.2 | 70.1 | 90.1 | 366 | 1 | 90791 H0004 H2014 | $174K |
| Nov 2020 | More hours than a day holds at a conservative unit price | 14.5 | 105.8 | 70.5 | 90.2 | 356 | 1 | 90791 H0004 H2014 | $171K |
| Dec 2020 | More hours than a day holds at a conservative unit price | 14.6 | 107.9 | 71.9 | 90.0 | 347 | 1 | 90791 H0004 H2014 | $175K |
| Jan 2021 | More hours than a day holds at a conservative unit price | 12.8 | 77.9 | 51.9 | 71.2 | 333 | 1 | 90791 H0004 H2014 | $151K |
| Feb 2021 | More hours than a day holds at a conservative unit price | 13.2 | 81.4 | 54.2 | 71.1 | 298 | 1 | 90791 H0004 H2014 | $141K |
| Mar 2021 | More hours than a day holds at a conservative unit price | 14.7 | 88.5 | 59.0 | 73.8 | 358 | 1 | 90791 H0004 H2014 | $172K |
| Apr 2021 | More hours than a day holds at a conservative unit price | 15.7 | 100.9 | 67.3 | 86.0 | 320 | 1 | 90791 H0004 H2014 | $187K |
| May 2021 | More hours than a day holds at a conservative unit price | 10.2 | 76.2 | 50.8 | 71.2 | 253 | 1 | 90791 H0004 H2014 | $143K |
| Jun 2021 | More hours than a day holds at a conservative unit price | 11.9 | 90.4 | 60.3 | 77.7 | 288 | 1 | 90791 H0004 H2014 | $165K |
| Jul 2021 | More hours than a day holds at a conservative unit price | 10.5 | 84.0 | 56.0 | 73.7 | 268 | 1 | 90791 H0004 H2014 | $161K |
| Aug 2021 | More hours than a day holds at a conservative unit price | 10.7 | 88.3 | 58.9 | 77.0 | 264 | 1 | 90791 H0004 H2014 | $171K |
| Sep 2021 | More hours than a day holds at a conservative unit price | 11.5 | 95.7 | 63.8 | 78.1 | 243 | 1 | H0004 H2014 | $184K |
| Oct 2021 | More hours than a day holds at a conservative unit price | 11.5 | 86.2 | 57.4 | 73.2 | 249 | 1 | 90791 H0004 H2014 | $179K |
| Nov 2021 | More hours than a day holds at a conservative unit price | 15.3 | 112.9 | 75.3 | 87.2 | 245 | 1 | 90791 H0004 H2014 | $231K |
| Dec 2021 | More hours than a day holds at a conservative unit price | 9.1 | 70.9 | 47.3 | 57.3 | 235 | 1 | 90791 H0004 H2014 | $142K |
| Jan 2022 | More hours than a day holds at a conservative unit price | 9.8 | 76.7 | 51.1 | 66.7 | 218 | 1 | 90791 H0004 H2014 | $164K |
| Feb 2022 | More hours than a day holds at a conservative unit price | 10.7 | 83.0 | 55.3 | 69.1 | 208 | 1 | 90791 H0004 H2014 | $159K |
| Mar 2022 | More hours than a day holds at a conservative unit price | 15.0 | 151.2 | 100.8 | 133.6 | 245 | 1 | 90791 H0004 H2014 | $306K |
| Apr 2022 | More hours than a day holds at a conservative unit price | 7.9 | 86.1 | 57.4 | 80.5 | 190 | 1 | 90791 H0004 H2014 | $168K |
| May 2022 | More hours than a day holds at a conservative unit price | 4.1 | 49.1 | 32.8 | 45.5 | 109 | 1 | H0004 H2014 | $99K |
| Jun 2022 | More hours than a day holds at a conservative unit price | 4.5 | 48.4 | 32.3 | 43.5 | 115 | 1 | 90791 H0004 H2014 | $95K |
| Jul 2022 | More hours than a day holds at a conservative unit price | 3.7 | 40.2 | 26.8 | 39.0 | 108 | 1 | 90791 H0004 H2014 | $81K |
| Aug 2022 | More hours than a day holds at a conservative unit price | 4.5 | 54.5 | 36.3 | 48.2 | 101 | 1 | H0004 H2014 | $109K |
| Sep 2022 | More hours than a day holds at a conservative unit price | 4.3 | 46.8 | 31.2 | 41.7 | 116 | 1 | 90791 H0004 H2014 | $92K |
| Oct 2022 | More hours than a day holds at a conservative unit price | 3.5 | 44.8 | 29.9 | 43.2 | 99 | 1 | H0004 H2014 | $90K |
| Nov 2022 | More hours than a day holds at a conservative unit price | 3.9 | 45.9 | 30.6 | 40.3 | 109 | 1 | H0004 H2014 | $90K |
| Dec 2022 | More hours than a day holds at a conservative unit price | 4.3 | 45.5 | 30.3 | 41.8 | 128 | 1 | 90791 H0004 H2014 | $93K |
| Jan 2023 | More hours than a day holds at a conservative unit price | 6.0 | 63.0 | 42.0 | 57.4 | 163 | 1 | 90791 H0004 H2014 | $126K |
| Feb 2023 | More hours than a day holds at a conservative unit price | 5.3 | 68.4 | 45.6 | 62.1 | 127 | 1 | H0004 H2014 | $122K |
| Mar 2023 | More hours than a day holds at a conservative unit price | 6.2 | 70.7 | 47.1 | 61.7 | 173 | 1 | 90791 H0004 H2014 | $141K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | PAUL CASTALDI, LICSW |
| Type | Individual, sole proprietor |
| Status | Active |
| NPI issued | October 25, 2011, last updated April 8, 2026 |
| Practice location | 256 HOPE ST, Bristol, RI 02809-2028, 401-855-7961 |
| Mailing address | 17581 CHARNWOOD DR, Boca Raton, FL 33498-6427 |
| Specialties | Social Worker, Clinical (1041C0700X, primary, license ISW01211 RI) Social Worker, Clinical (1041C0700X, license SW21022 FL) |
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 | |
|---|---|---|---|---|---|---|---|
| H0004 | Behavioral health counseling and therapy per 15 minhistory of abuse | $4.4M | 85% | $880 | $174 (top 5% from $559) | 97th percentile | |
| H2014 | Skills training and development per 15 minhistory of abuse | $665K | 13% | $280 | $298 (top 5% from $3K) | 48th percentile | |
| 90791 | Psychiatric diagnostic evaluation | $94K | 2% | $123 | $105 (top 5% from $228) | 69th 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 |
|---|---|---|---|---|---|---|---|---|
| 90791 | Psychiatric diagnostic evaluation | 12 | 12 | $1K | $308 | $129 | 2.4x | 1.9x (90th percentile 3.6x) |
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
35 providers in RI carry an indicator in the public record, with $45.0M at stake between them. The most common is part of a provider network, on 17 of them, followed by more hours than a day holds on 15. 1 is tier 1: documented action, then payment.
| tier | provider | at stake | why |
|---|---|---|---|
| 1 | CARE CENTER RHODE ISLAND LLC East Providence, RI, ranked 100 | $270K |
|
| 3 | BEACON HOSPICE, LLC East Providence, RI, ranked 989 | $1.7M |
|
| 3 | ODYSSEY HEALTHCARE OPERATING B LP Warwick, RI, ranked 1050 | $955K |
|
| 3 | ROYAL MIDDLETOWN NURSING CENTER LLC Middletown, RI, ranked 1073 | $816K |
|
| 3 | VISITING NURSE SERVICES OF NEWPORT AND BRISTOL COUNTIES Middletown, RI, ranked 1291 | $177K |
|
| 3 | CORTLAND PLACE REHAB CENTER LLC Greenville, RI, ranked 1385 | $75K |
|
| 3 | EDEN HOSPICE LLC Warwick, RI, ranked 2934 | $0 |
|
| 3 | OVERLOOK EDEN OPERATIONS, LLC Pascoag, RI, ranked 3154 | $0 |
|
Recent enforcement in RI
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
DOJIndictedJun 24, 2026
Two Charged in District of Rhode Island as Part of National Fraud Takedown
Two defendants were charged by indictment with using the identity of another person to obtain benefits, including approximately $28,236.42 and $24,018.86 in Rhode Island Medicaid benefits.
DOJOtherFeb 17, 2026
Zynex, Inc. Agrees to Criminal Resolution Addressing Claims of Millions of Dollars of Health Care Fraud, Securities Fraud and Related Offenses
Zynex admitted to submitting excessive and improper claims for medical devices and supplies, including medically unnecessary electrode supplies in excess quantities, to government and private health care payors and patients, and to concealing from investors that its revenues were driven by fraudulent billing.
DOJIndictedJan 21, 2026
Former Zynex, Inc. Executives Charged with Health Care and Securities Fraud and Related Offenses
The indictment alleges that from at least 2017 through late 2025 the former CEO and COO of Zynex, Inc. caused the company to submit fraudulent billings to government and private health care payors and patients for medical devices and supplies that were not medically necessary, not covered, and not agreed to by patients, and used those billings to inflate the company's financial reporting and stock price.
DOJIndictedApr 7, 2025
Pain Management Clinic Owners and Operators Indicted on Health Care Fraud Charges
The owners and operators of a pain management clinic allegedly submitted fraudulent claims to Medicare, Medicare Advantage, Medicaid Managed Care, and four private insurers for purportedly medically necessary services, including acupuncture, physical therapy, and office visits, that were not actually provided to patients, in order to collect payment for massage therapy and other services not provided.
DOJSentencedMar 5, 2025
Addiction Treatment Center Supervisor Sentenced in Scheme to Defraud Federal, State, and Private Health Care Insurers
A clinical social worker supervisor at an addiction treatment center devised and executed a scheme to submit false claims for 45-minute psychotherapy and counseling sessions that lasted only 5-10 minutes or did not occur as billed, defrauding Medicare, Medicaid, and other health insurers of more than $3.5 million.
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.