Providers
MARIO A RODRIGUEZ, M.D.
NPI 1528086006, individual, Rio Grande City, TX, Family Medicine
5
Evidence tier
informational
- Medicaid dollars per patient on code 99444 ($235 per patient-month) sit in the top 5% of every provider billing that code.
score 35 of 100, rank 10059, $1.3M at stake
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | MARIO A RODRIGUEZ, M.D. |
| Type | Individual |
| Status | Active |
| NPI issued | July 17, 2006, last updated June 11, 2014 |
| Practice location | 201 N FM 3167 STE 109, Rio Grande City, TX 78582-6725, 956-263-1671 |
| Specialties | Family Medicine (207Q00000X, primary, license K3639 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 | |
|---|---|---|---|---|---|---|---|
| 99444 | Medicaid service code | $2.0M | 56% | $235 | $208 (top 5% from $234) | 96th percentile | |
| 99423 | Online digital evaluation and management service for an established patient for up to 7 days, total time 21 or more minutes | $1.2M | 32% | $118 | $118 (top 5% from $231) | 50th percentile | |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | $272K | 8% | $22 | $44 (top 5% from $110) | 18th percentile | |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $62K | 2% | $19 | $60 (top 5% from $133) | 10th percentile | |
| 99091 | Collection and interpretation of physical parameters stored in computers and/or transmitted by the patient and/or caregiver to qualified health care professional, requiring 30 minutes or more, per 30 days | $37K | 1% | $5.60 | $48 (top 5% from $168) | 21st 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 | $20K | 1% | $20 | $88 (top 5% from $210) | 8th percentile | |
| 96372 | Injection of drug or substance under skin or into muscle | $17K | 0% | $6.22 | $12 (top 5% from $49) | 30th percentile | |
| 99421 | Online digital evaluation and management service for an established patient for up to 7 days, total time 5-10 minutes | $5K | 0% | $25 | $13 (top 5% from $71) | 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 |
|---|---|---|---|---|---|---|---|---|
| 99423 | Online digital evaluation and management service for an established patient for up to 7 days, total time 21 or more minutes | 2,477 | 83 | $82K | $65 | $45 | 1.5x | 2.4x (90th percentile 5.1x) |
| 99215 | Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more | 297 | 87 | $37K | $173 | $169 | 1.0x | 2.4x (90th percentile 4.1x) |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | 461 | 164 | $25K | $99 | $86 | 1.1x | 2.2x (90th percentile 3.8x) |
| 99457 | Management using the results of remote vital sign monitoring per calendar month, first 20 minutes | 516 | 72 | $19K | $75 | $46 | 1.6x | 2.2x (90th percentile 3.5x) |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | 220 | 111 | $18K | $127 | $122 | 1.0x | 2.3x (90th percentile 3.8x) |
| 99458 | Management using the results of remote vital sign monitoring per calendar month, each additional 20 minutes | 426 | 58 | $13K | $65 | $37 | 1.7x | 2.2x (90th percentile 3.5x) |
| G0179 | Physician or allowed practitioner re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians a | 240 | 52 | $7K | $75 | $40 | 1.9x | 2.1x (90th percentile 3.3x) |
| 99454 | Remote monitoring of physiologic parameters, initial supply of devices with daily recordings or programmed alerts transmission, each 30 days | 148 | 21 | $5K | $95 | $44 | 2.2x | 2.6x (90th percentile 4.2x) |
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
5 providers in Starr County, TX carry an indicator in the public record, with $3.2M at stake between them. The most common is more hours than a day holds, on 4 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 | CELIA ZUNIGA Rio Grande City, TX, ranked 249 | $19K |
|
| 4 | DARIA BABINEAUX Rio Grande City, TX, ranked 8798 | $1.7M |
|
| 4 | ARTEMIO GARCIA Rio Grande City, TX, ranked 9393 | $269K |
|
| 5 | MARIA VALDEZ Roma, TX, ranked 10944 | $1.2M | |
| 5 | YVETTE BELTRAN DBA LOS GIRASOLES ADULT DAY Rio Grande City, TX, ranked 11838 | $28K |
Recent enforcement in TX
All releasesDepartment 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
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.