TARA JONES, M.D.

NPI 1487965315, individual, Richfield Springs, NY, Family Medicine

Evidence tier

structure or single-organization volume

Hours beyond a day in 5 months, but with up to 812 patients a month, which points to a supervising clinician on the claims rather than one person's hours.
Records needed.
Medicaid dollars per patient on code 99213 ($255 per patient-month) sit in the top 5% of every provider billing that code.

score 55 of 100, rank 7773, $1.3M 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
Jul 2023	More hours than a day holds, even counting one unit per claim line	26.2	28.9	19.3	28.5	812	1	99213 99214	$151K
Aug 2023	More hours than a day holds, even counting one unit per claim line	27.2	30.1	20.0	27.0	703	1	99213 99214	$161K
Sep 2023	More hours than a day holds, even counting one unit per claim line	27.0	29.6	19.8	28.2	698	1	99213 99214	$156K
Oct 2023	More hours than a day holds, even counting one unit per claim line	30.5	33.1	22.1	31.1	730	1	99213 99214	$184K
Nov 2023	More hours than a day holds, even counting one unit per claim line	34.4	37.0	24.7	33.7	703	1	99213 99214	$201K

National provider registry

From the CMS NPPES Registry, refreshed daily.

Name	TARA JONES, M.D.
Type	Individual
Status	Active
NPI issued	June 25, 2010, last updated December 13, 2018
Practice location	8550 STATE HIGHWAY 28, Richfield Springs, NY 13439-4830, 315-858-0040
Mailing address	1123 COUNTY HIGHWAY 26, Fly Creek, NY 13337-2703
Specialties	Family Medicine (207Q00000X, primary, license 275577 NY)

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	$1.2M	57%	$203	$44 (top 5% from $110)	99th percentile
99214	Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	$590K	27%	$171	$60 (top 5% from $133)	98th percentile
99215	Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or morehistory of abuse	$335K	16%	$255	$88 (top 5% from $210)	97th percentile
G0442	Annual alcohol misuse screening, 5 to 15 minutes	$53	0%	$1.71	$3.03 (top 5% from $22)	too few months to rank

In this area

3 providers in Otsego County, NY carry an indicator in the public record, with $1.9M at stake between them. The most common is more hours than a day holds, on 2 of them, followed by part of a provider network on 1.

tier	provider	at stake	why
3	ORNC LLC Oneonta, NY, ranked 5422	$0	Part of provider network D1-00091, ranked 91 nationally.
5	RICHARD BENNETT Cooperstown, NY, ranked 11022	$996K
5	CELESTE JOHNS Cooperstown, NY, ranked 11049	$931K

Recent enforcement in NY

All releases

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

DOJIndictedAug 20, 2026

Four Members Of The “War Room” Charged In Connection With $12 Million Medicaid Fraud Scheme

Members of a Bronx-based racketeering organization known as the "War Room" fabricated ride data for methadone clinic transportation using a GPS spoofing application, paid Medicaid patients kickbacks in cash and drugs for their enrollment information, provided the fake data to transportation companies that submitted over $12 million in claims to Medicaid, and laundered the proceeds.

DOJIndictedAug 20, 2026

Four Members of the “War Room” Charged in Connection with $12M Medicaid Fraud Scheme

Four members of a Bronx racketeering organization known as the "War Room" fabricated medical transportation ride data using a ride-tracking app and GPS spoofing, paid Medicaid patients at methadone clinics kickbacks in cash and drugs for their enrollment information, provided the fake data to transportation companies that submitted over $12 million in Medicaid claims, and laundered the proceeds.

DOJCivil settlementAug 17, 2026

Safire nursing homes agree to pay $9 million to resolve fraudulent Medicare and Medicaid billing allegations

The United States alleged that Safire submitted false claims to Medicare and Medicaid for skilled rehabilitative therapy services that were not reasonable or necessary, not supported by medical records, not documented as provided, or not provided at all, including by scheduling therapy based on insurer reimbursement policies, pressuring therapists and residents, and manufacturing or altering therapy referrals and medical records.

DOJSentencedJul 21, 2026

Owner of Long Island Ambulette Services Company Sentenced to Prison for Multimillion Dollar Healthcare Fraud Scheme

Arshad and co-conspirators paid kickbacks to Medicaid beneficiaries to order transportation through his companies and billed Medicaid over $19 million for medical transportation rides that were not provided, including for individuals who were deceased, hospitalized or incarcerated, and inflated reimbursements with false pickup addresses and distant treatment centers.

DOJIndictedJul 2, 2026

Two Defendants Charged with Multi-Million Dollar Health Care Fraud Scheme

The defendants, who owned and operated Tri-Hamlet Taxi Inc., allegedly paid kickbacks to Medicaid beneficiaries and submitted more than $35 million in claims to Medicaid for ambulette trips that were not provided or whose costs were inflated by using false pickup or drop-off addresses.

Referral packet

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