Providers
All 11 in CA
ADULT MEDICINE SPECIALISTS, INC
NPI 1407842339, organization, Sonora, CA, Internal Medicine
1
Evidence tier
documented action, then payment
- Listed on the Medicare revocation list since July 25, 2018.
- Medicaid still paid claims in 4 later months, $1,898 in total.
score 93 of 100, rank 369, $2K at stake
Public list actions
Medicare revocation effective July 25, 2018, barred from re-enrolling until July 25, 2028
424.535(a)(4) false or misleading information and 424.535(a)(9) failure to report and 424.535(a)(12) other program termination (medicaid) and 424.535(a)(3) felonies, Part B Supplier - Clinic/Group Practice, CA
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)(4) false or misleading information and 424.535(a)(9) failure to report and 424.535(a)(12) other program termination (medicaid) and 424.535(a)(3) felonies | Exact NPI, name verified | Jul 25, 2018 | Jul 25, 2028 | 4 | Aug 2018 | Nov 2018 | $2K | $3K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | ADULT MEDICINE SPECIALISTS, INC |
| Type | Organization |
| Status | Active |
| NPI issued | September 26, 2005, last updated November 19, 2015 |
| Practice location | 690 GUZZI LN, STE C, Sonora, CA 95370-5289, 209-533-0333 |
| Authorized official | Danny Anderson (Owner) |
| Specialties | Internal Medicine (207R00000X, primary, license G033960 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 | $5K | 100% | $17 | $60 (top 5% from $133) | too few months to rank |
In this area
11 providers in Tuolumne County, CA carry an indicator in the public record, with $4.2M at stake between them. The most common is more hours than a day holds, on 8 of them, followed by part of a provider network on 3.
| tier | provider | at stake | why |
|---|---|---|---|
| 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 | ROBERT REINA Sonora, CA, ranked 7656 | $2.2M |
|
| 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.