CLOREESE WILKINSON-RIVERA, LMHC

NPI 1528471471, individual, Kennewick, WA, Marriage & Family Therapist

Evidence tier

structure or single-organization volume

Hours beyond a day in 8 months under one organization, which can be supervisory billing.
Records needed.
99% of Medicaid dollars are on codes with a history of abuse.

score 53 of 100, rank 8208, $733K 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
Nov 2018	More hours than a day holds, even counting one unit per claim line	24.3	22.9	15.2	20.8	122	1	90837	$43K
Dec 2018	More hours than a day holds, even counting one unit per claim line	24.3	22.5	15.0	22.1	130	1	90837	$44K
Jan 2019	More hours than a day holds, even counting one unit per claim line	28.4	24.0	16.0	21.5	137	1	90837	$50K
Feb 2019	More hours than a day holds, even counting one unit per claim line	28.0	24.6	16.4	22.9	144	1	90837	$46K
Mar 2019	More hours than a day holds, even counting one unit per claim line	28.9	25.2	16.8	24.8	154	1	90791 90837	$52K
Apr 2019	More hours than a day holds, even counting one unit per claim line	29.2	25.8	17.2	23.5	135	1	90837	$52K
May 2019	More hours than a day holds, even counting one unit per claim line	27.0	23.8	15.9	21.4	133	1	90837	$49K
Jun 2019	More hours than a day holds, even counting one unit per claim line	24.6	22.0	14.6	22.0	117	1	90837	$44K

National provider registry

From the CMS NPPES Registry, refreshed daily.

Name	CLOREESE WILKINSON-RIVERA, LMHC
Type	Individual, sole proprietor
Status	Active
NPI issued	June 9, 2014, last updated April 12, 2017
Practice location	2628 W BRUNEAU PL, SUITE 110, Kennewick, WA 99336-3134, 509-420-6340
Specialties	Marriage & Family Therapist (106H00000X, primary, license LH 60579027 WA)

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
90837	Psychotherapy, 1 hourhistory of abuse	$751K	99%	$321	$191 (top 5% from $442)	87th percentile
90791	Psychiatric diagnostic evaluation	$6K	1%	$60	$105 (top 5% from $228)	21st percentile

In this area

5 providers in Benton County, WA carry an indicator in the public record, with $1.8M at stake between them. The most common is paid after a public list action, on 2 of them, followed by part of a provider network on 2. 1 is tier 1: documented action, then payment.

tier	provider	at stake	why
1	ZAIN MEDICAL CENTER Richland, WA, ranked 87	$426K	Listed on the Medicare revocation list since November 22, 2019. Medicaid still paid claims in 13 later months, $425,774 in total.
3	SUNNYSIDE HOME HEALTH Sunnyside, WA, ranked 3148	$0	Part of provider network D1-00104, ranked 104 nationally.
3	RICHLAND MEDICAL INVESTORS, LLC Richland, WA, ranked 4311	$0	Part of provider network D1-00104, ranked 104 nationally.
5	BENJAMIN PE Richland, WA, ranked 10052	$1.3M	Medicaid dollars per patient on code 99214 ($229 per patient-month) sit in the top 5% of every provider billing that code.
5	EDWARD SALKO Kennewick, WA, ranked 11756	$48K

Recent enforcement in WA

All releases

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

DOJSentencedMar 27, 2026

Local Physician Sentenced to 1 Year Imprisonment, a $60,000 fine, and Restitution of $349,272.79 for Adulterating and Misbranding Medical Devices with the Intent to Defraud

Haeger purchased over 500 used and recalled CPAP and BiPAP devices, had the sound abatement foam removed outside clean room conditions, provided the devices to Washington State Medicaid patients through his sleep clinic, and billed Medicaid representing them as new devices in good working order.

DOJCivil settlementJan 12, 2026

DOJ and Seattle-based FidaLab, LLC settle allegations it inflated bills to government health care programs

FidaLab billed Medicare for a series of urinary tract infection tests under multiple billing codes instead of a single code after its request to bill the tests as a panel was denied.

DOJPleaded guiltyDec 18, 2025

Local Physician Pleads Guilty to Adulterating and Misbranding Medical Devices with the Intent to Defraud

Physician purchased over 500 used and recalled CPAP and BiPAP devices, had the sound abatement foam removed outside of clean room conditions, provided the devices to Washington State Medicaid patients, and had staff bill Medicaid representing them as new devices in good working order.

DOJCivil settlementDec 10, 2025

Spokane Physician Pays $120,000 to Resolve Allegations He Prescribed Controlled Substances Without Legitimate Medical Purpose

Between 2017 and 2025 a licensed physician issued over 1,400 prescriptions for controlled substances to thirteen identified patients that lacked legitimate medical purposes or were outside the usual course of professional practice, failing to address red flags of substance abuse.

DOJSentencedDec 2, 2025

Indian national sentenced to prison for Medicare fraud scheme that stole more than $1 million in taxpayer funds

Asif conspired with others to bill Medicare for COVID-19 tests and other respiratory illness tests that had not been ordered or performed through American Labworks LLC.

Referral packet

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