Providers
FRANCISCO N ALVARADO MELENDEZ, M.D.
NPI 1437199593, individual, Caguas, PR, Internal Medicine, Infectious Disease
4
Evidence tier
structure or single-organization volume
- Hours beyond a day in 1 month under one organization, which can be supervisory billing.
- Records needed.
- Medicaid dollars per patient on code 99223 ($201 per patient-month) sit in the top 5% of every provider billing that code.
score 54 of 100, rank 8033, $198K 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 |
|---|---|---|---|---|---|---|---|---|---|
| Oct 2024 | More hours than a day holds, even counting one unit per claim line | 25.7 | 30.5 | 20.3 | 27.4 | 123 | 1 | 99223 99232 | $109K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | FRANCISCO N ALVARADO MELENDEZ, M.D. |
| Type | Individual, sole proprietor |
| Status | Active |
| NPI issued | June 7, 2006, last updated October 25, 2024 |
| Practice location | ST 172 EXIT 21 TURABO GARDENS, CARR CAGUAS A CIDRA, Caguas, PR 00725-7084, 787-744-1577 |
| Mailing address | 208 CALLE GUAMA, URB SABANERA DEL RIO, Gurabo, PR 00778-5232 |
| Specialties | Internal Medicine, Infectious Disease (207RI0200X, primary, license 14625 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 | |
|---|---|---|---|---|---|---|---|
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | $667K | 57% | $201 | $67 (top 5% from $174) | 97th percentile | |
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | $388K | 33% | $198 | $81 (top 5% from $170) | 98th percentile | |
| 99254 | Medicaid service code | $57K | 5% | $51 | $90 (top 5% from $178) | 10th percentile | |
| 99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | $25K | 2% | $80 | $96 (top 5% from $249) | 37th percentile | |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $24K | 2% | $111 | $60 (top 5% from $133) | 90th percentile | |
| 99253 | Medicaid service code | $2K | 0% | $59 | $60 (top 5% from $116) | too few months to rank | |
| 99204 | New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more | $2K | 0% | $136 | $95 (top 5% from $171) | too few months to rank |
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 |
|---|---|---|---|---|---|---|---|---|
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | 241 | 36 | $15K | $78 | $76 | 1.0x | 2.6x (90th percentile 4.3x) |
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | 41 | 36 | $5K | $171 | $168 | 1.0x | 3.0x (90th percentile 5.6x) |
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
7 providers in Caguas Municipio County, PR carry an indicator in the public record, with $8.3M at stake between them. The most common is more hours than a day holds, on 6 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 | DIANA GALLARDO Caguas, PR, ranked 321 | $5K |
|
| 2 | YAMIR GARCIA SEGARRA Caguas, PR, ranked 696 | $1.9M |
|
| 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.