Providers
All 32 in MA
ANTHONY EMILIO ADDESA, M.D.
NPI 1538186119, individual, Somerville, MA, Internal Medicine
1
Evidence tier
documented action, then payment
- Listed on the SC Medicaid exclusion list since September 19, 2024.
- Medicaid still paid claims in 1 later month, $73 in total.
score 92 of 100, rank 448, $73 at stake
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 |
|---|---|---|---|---|---|---|---|---|
| SC Medicaid exclusion list state list extracted from https://www.scdhhs.gov/sites/dhhs/files/08%2027%202026%20sc%20medicaid%20sanctioned%20individuals patricia%20k%20godley.xlsx (pandas claude colmap) | Exact NPI, name verified | Sep 19, 2024 | still open | 1 | Oct 2024 | Oct 2024 | $73 | $5K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | ANTHONY EMILIO ADDESA, M.D. |
| Type | Individual |
| Status | Active |
| NPI issued | July 17, 2006, last updated June 20, 2025 |
| Practice location | 783 SOMERVILLE AVE, Somerville, MA 02143-3541, 805-971-1428 |
| Specialties | Internal Medicine (207R00000X, primary, license 236898 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 | |
|---|---|---|---|---|---|---|---|
| 99442 | Telephone medical discussion with physician, 11-20 minutes | $5K | 72% | $17 | $21 (top 5% from $104) | too few months to rank | |
| 99443 | Telephone medical discussion with physician, 21-30 minutes | $979 | 16% | $36 | $31 (top 5% from $184) | too few months to rank | |
| 99441 | Telephone medical discussion with physician, 5-10 minutes | $388 | 6% | $7.76 | $11 (top 5% from $106) | too few months to rank | |
| 99349 | Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes | $339 | 5% | $10 | $30 (top 5% from $115) | too few months to rank | |
| 99497 | Advance care planning, first 30 minutes | $60 | 1% | $2.99 | $11 (top 5% from $62) | too few months to rank | |
| 3077F | Medicaid service code | $0 | 0% | $0.00 | $0.00 (top 5% from $1.28) | too few months to rank | |
| 3079F | Medicaid service code | $0 | 0% | $0.00 | $0.00 (top 5% from $1.06) | too few months to rank | |
| 3078F | Medicaid service code | $0 | 0% | $0.00 | $0.00 (top 5% from $0.82) | 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 |
|---|---|---|---|---|---|---|---|---|
| 99442 | Telephone medical discussion with physician, 11-20 minutes | 43 | 32 | $4K | $136 | $103 | 1.3x | 2.1x (90th percentile 3.7x) |
| 99349 | Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes | 18 | 17 | $2K | $186 | $142 | 1.3x | 2.0x (90th percentile 3.4x) |
| 99490 | Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month | 15 | 14 | $845 | $94 | $71 | 1.3x | 1.8x (90th percentile 2.9x) |
| 99441 | Telephone medical discussion with physician, 5-10 minutes | 13 | 13 | $668 | $85 | $64 | 1.3x | 2.1x (90th percentile 3.9x) |
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
32 providers in Middlesex County, MA carry an indicator in the public record, with $22.6M at stake between them. The most common is part of a provider network, on 16 of them, followed by more hours than a day holds on 9. 5 are tier 1: documented action, then payment.
| tier | provider | at stake | why |
|---|---|---|---|
| 1 | MELVIN EHRLICH Framingham, MA, ranked 152 | $91K |
|
| 1 | ARBOR HOMECARE SERVICES LLC Chelmsford, MA, ranked 503 | $0 |
|
| 1 | ADVANCED TMS ASSOCIATES LLC Natick, MA, ranked 562 | $0 |
|
| 1 | GUSTAVO KINRYS Cambridge, MA, ranked 580 | $0 |
|
| 1 | RICHARD MIRON Dracut, MA, ranked 650 | $0 |
|
| 3 | TUFTS MEDICINE CARE AT HOME, INC. Lowell, MA, ranked 966 | $2.2M |
|
| 3 | HOSPICE OF THE GOOD SHEPHERD, INC. Newton, MA, ranked 1000 | $1.5M |
|
| 3 | MERRIMACK VALLEY OPERATIONS, LLC North Billerica, MA, ranked 1055 | $913K |
|
Recent enforcement in MA
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
DOJIndictedSep 4, 2026
Illegal Alien from Georgia Charged for Conspiracy to Launder Proceeds of $1.3B Health Care Fraud Scheme
Gugava purportedly owned ND Medical Solutions LLC, a durable medical equipment company that submitted at least $1.3 billion in fraudulent DME claims to Medicare and other insurers using stolen identities, and he opened bank accounts to deposit and transfer the fraud proceeds to overseas accounts.
DOJIndictedSep 4, 2026
Georgian National Charged for Conspiracy to Launder Proceeds of $1.3 Billion Health Care Fraud Scheme
Gugava allegedly served as purported owner of ND Medical Solutions, LLC, which submitted at least $1.3 billion in fraudulent durable medical equipment claims to Medicare and private insurers using stolen identities, and he opened bank accounts to deposit and transfer the proceeds overseas.
DOJSentencedAug 20, 2026
Former Owner of Telemedicine Companies Sentenced to Two Years in Prison for $110 Million Medicare Fraud Scheme
Through his telemedicine companies, Richardson generated prepopulated durable medical equipment orders signed by doctors and nurses without beneficiary contact and sold them to telemarketers who resold them to DME suppliers that billed Medicare for medically unnecessary equipment.
DOJCivil settlementAug 10, 2026
Veloxis Pharmaceuticals Agrees to Pay $46 Million to Resolve Criminal and Civil Liability for Kickback Scheme
Veloxis paid kickbacks in the form of lavish meals, alcohol, luxury resort stays, personal gifts and sham consulting payments to transplant health care professionals, and per-patient and per-month payments to specialty pharmacies, to induce prescriptions and purchases of Envarsus XR, causing false claims to federal health care programs and underreporting payments under the Open Payments Program.
DOJCivil settlementAug 10, 2026
Veloxis Pharmaceuticals Agrees to Pay Over $46M to Resolve Criminal and Civil Liability for Kickback Schemes
Veloxis paid kickbacks in the form of lavish meals, alcohol, gifts, trips and resort stays, and purported consulting fees to health care providers, and per-patient and per-month payments to specialty pharmacies, to induce prescriptions and purchases of Envarsus XR, and concealed those payments through falsified expense reports that resulted in underreporting to CMS's Open Payments Program.
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.