RAPHAEL SANTANA, FNP

NPI 1417348186, individual, Eagle Pass, TX, Nurse Practitioner, Family

Evidence tier

documented action, then payment

Listed on the Medicare revocation list since September 16, 2019.
Medicaid still paid claims in 22 later months, $5,330 in total.

score 94 of 100, rank 318, $5K at stake

Public list actions

Medicare revocation effective September 16, 2019, barred from re-enrolling until September 16, 2029

424.535(a)(9) failure to report and 424.535(a)(3) felonies and 424.535(a)(2) provider or supplier conduct (exclusion), Practitioner - Nurse Practitioner, TX

OIG exclusion December 20, 2023 under section 1128a4

Ind- Lic HC Serv Pro, Nurse Practitioner (, Eagle Pass, TX

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	Sep 16, 2019	Sep 16, 2029	22	Oct 2019	Apr 2022	$5K	$3K

National provider registry

From the CMS NPPES Registry, refreshed daily.

Name	RAPHAEL SANTANA, FNP
Type	Individual, sole proprietor
Status	Active
NPI issued	February 16, 2015, last updated February 16, 2015
Practice location	161 HERITAGE FARMS DR, Eagle Pass, TX 78852-6656, 830-513-5230
Specialties	Nurse Practitioner, Family (363LF0000X, primary, license AP127348 TX)

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	$6K	67%	$10	$44 (top 5% from $110)	11th percentile
99214	Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	$3K	33%	$23	$60 (top 5% from $133)	11th percentile
36415	Insertion of needle into vein for collection of blood sample	$0	0%	$0.00	$1.97 (top 5% from $12)	0th percentile

In this area

399 providers in TX carry an indicator in the public record, with $456.5M at stake between them. The most common is part of a provider network, on 347 of them, followed by named in an enforcement record on 27. 43 are tier 1: documented action, then payment.

tier	provider	at stake	why
1	KELLY TURNER Amarillo, TX, ranked 16	$89K	Listed on the TX Medicaid exclusion list since October 22, 2018. Medicaid still paid claims in 14 later months, $88,543 in total. and 1 more
1	BLAKES BLESSING HEALTH CARE INC. Houston, TX, ranked 24	$2.1M	Listed on the TX Medicaid exclusion list since January 19, 2022. Medicaid still paid claims in 33 later months, $2,118,903 in total. and 1 more
1	MERCRIS HOME HEALTH INC Richmond, TX, ranked 29	$899K	Listed on the Medicare revocation list since May 1, 2023. Medicaid still paid claims in 17 later months, $899,287 in total. and 1 more
1	COMMUNITY CARE MEDICAL CLINICS INC Mansfield, TX, ranked 63	$961K	Listed on the Medicare revocation list since March 2, 2020. Medicaid still paid claims in 19 later months, $960,939 in total.
1	NICOLAS AGUILAR Arlington, TX, ranked 147	$102K	Listed on the Medicare revocation list since May 8, 2019. Medicaid still paid claims in 21 later months, $101,959 in total.
1	MARK MAZZARE Tyler, TX, ranked 159	$79K	Adjudicated (pleaded guilty) per a Department of Justice release dated December 16, 2024. Medicaid paid $79,337 in the last 12 observed months.
1	EUGENE S MACKIE MD PA Edinburg, TX, ranked 161	$74K	Listed on the Medicare revocation list since September 7, 2018. Medicaid still paid claims in 33 later months, $74,283 in total.
1	EUGENE MACKIE Edinburg, TX, ranked 167	$68K	Listed on the Medicare revocation list since September 7, 2018. Medicaid still paid claims in 33 later months, $67,762 in total.

All 399 in TX

Recent enforcement in TX

All releases

Department of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.

DOJCivil settlementAug 26, 2026

Dallas medical clinic to pay $7.5 million to resolve COVID-19 testing overbilling allegations

Aymancare billed the federal government's HRSA Uninsured Program for separate evaluation and management services in addition to COVID-19 specimen collection and testing at pop-up testing sites when no such separate services were performed.

DOJConvictedAug 12, 2026

Scammer pharmacist guilty in $20 million healthcare kickback scheme

Thomas paid over $2 million in kickbacks to the owner of a Houston clinic in exchange for referrals of DOL-OWCP insured patients prescribed high-reimbursement compounded medications, which his pharmacy then billed to DOL-OWCP, receiving more than $20 million in reimbursements.

DOJIndictedJun 24, 2026

U.S. Attorney Announces Major Health Care Fraud Cases in Western District of Texas

Charles is alleged to have received illegal kickbacks for referring patients to San Antonio area hospice companies, causing over $9 million in Medicare claims, while Dr. Duncan settled allegations of billing Medicare and TRICARE for an unapproved amniotic-based product and Trevor's Place settled allegations of submitting inflated TRICARE claims for services not provided.

DOJIndictedJun 23, 2026

Nine charged in SDTX as part of national health care fraud takedown

Nine defendants were indicted in the Southern District of Texas for operating pill mill clinics and a pharmacy that unlawfully distributed controlled substances, billing Medicaid $16 million for mental health services for minors that did not occur, and billing Medicare and TRICARE approximately $906 million for medically unnecessary amniotic wound allografts procured through kickbacks.

DOJChargedJun 23, 2026

Northern District of Texas Charges 13 Health Care Fraudsters for Loss Over $360 Million

Thirteen defendants in the Northern District of Texas were charged in seven cases involving more than $365 million in fraudulent billing to federally-funded programs and other insurers, including laboratory and genetic testing claims procured through kickbacks, transcranial magnetic stimulation treatments billed to TRICARE, medically unnecessary EEG testing, and hospice services never provided.

Referral packet

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