FERNANDO PALACIOS, M.D.

NPI 1629383534, individual, Wildomar, CA, Family Medicine

Evidence tier

documented action, then payment

Listed on the CA Medicaid exclusion list and the Medicare revocation list since June 27, 2024.
Medicaid still paid claims in 4 later months, $4,063 in total.

score 94 of 100, rank 334, $4K at stake

Public list actions

Medicare revocation effective June 27, 2024, barred from re-enrolling until June 26, 2034

424.535(a)(19) affiliation that poses an undue risk, Practitioner - Emergency Medicine, CA

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
CA Medicaid exclusion list ca medi-cal suspended & ineligible provider list (july 2026)	Exact NPI, name verified	Jun 27, 2024	still open	4	Jul 2024	Nov 2024	$4K	$10K
Medicare revocation list 424.535(a)(19) affiliation that poses an undue risk	Exact NPI, name verified	Jun 27, 2024	Jun 26, 2034	4	Jul 2024	Nov 2024	$4K	$10K

National provider registry

From the CMS NPPES Registry, refreshed daily.

Name	FERNANDO PALACIOS, M.D.
Type	Individual
Status	Active
NPI issued	August 16, 2010, last updated July 21, 2022
Practice location	36485 INLAND VALLEY DR, Wildomar, CA 92595-9681, 323-945-9345
Specialties	General Practice (208D00000X, license 145668 CA) Family Medicine (207Q00000X, primary, license 145668 CA)

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
99223	Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	$80K	41%	$65	$81 (top 5% from $170)	33rd percentile
99233	Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	$52K	27%	$86	$96 (top 5% from $249)	42nd percentile
99239	Hospital discharge day management, more than 30 minutes	$30K	15%	$44	$49 (top 5% from $101)	41st percentile
99232	Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	$25K	13%	$68	$67 (top 5% from $174)	51st percentile
99238	Hospital discharge day management, 30 minutes or less	$8K	4%	$35	$48 (top 5% from $80)	29th percentile
99222	Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	$966	0%	$60	$63 (top 5% from $137)	too few months to rank
99407	Smoking and tobacco use intensive counseling, more than 10 minutes	$271	0%	$23	$14 (top 5% from $36)	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
99233	Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	56	29	$5K	$666	$116	5.7x	2.6x (90th percentile 4.7x)
99232	Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	78	44	$5K	$262	$78	3.4x	2.6x (90th percentile 4.3x)
99239	Hospital discharge day management, more than 30 minutes	42	42	$4K	$390	$113	3.5x	2.8x (90th percentile 5.6x)
99223	Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	23	23	$3K	$1K	$170	6.7x	3.0x (90th percentile 5.6x)
99222	Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	21	20	$2K	$431	$129	3.4x	2.7x (90th percentile 4.4x)
G0181	Physician or allowed practitioner supervision of a patient receiving medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician or allow	20	15	$2K	$169	$107	1.6x	1.6x (90th percentile 2.9x)
99231	Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes	24	12	$938	$151	$49	3.1x	2.4x (90th percentile 4.0x)
99497	Advance care planning, first 30 minutes	11	11	$642	$211	$74	2.9x	2.3x (90th percentile 4.9x)

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

178 providers in Riverside County, CA carry an indicator in the public record, with $225.2M at stake between them. The most common is more hours than a day holds, on 113 of them, followed by part of a provider network on 58. 4 are tier 1: documented action, then payment.

tier	provider	at stake	why
1	PHLEBXPRESS Temecula, CA, ranked 20	$45K	Listed on the Medicare revocation list since January 20, 2023. Medicaid still paid claims in 14 later months, $45,245 in total. and 1 more
1	BABAR IQBAL MD INC Riverside, CA, ranked 267	$13K	Listed on the Medicare revocation list since June 10, 2020. Medicaid still paid claims in 3 later months, $12,584 in total.
1	BABAR IQBAL Riverside, CA, ranked 268	$13K	Listed on the Medicare revocation list since June 10, 2020. Medicaid still paid claims in 3 later months, $12,584 in total.
1	BORREGO COMMUNITY HEALTH FOUNDATION Lake Elsinore, CA, ranked 495	$0	Adjudicated (sentenced, charged) per a state attorney general release dated July 22, 2024. No Medicaid payments in the last 12 observed months.
3	HIGH CARE HOSPICE, INC. Riverside, CA, ranked 923	$4.9M	Part of provider network D1-00031, ranked 31 nationally.
3	AGAPE GROUP, INC Corona, CA, ranked 946	$2.8M	Part of provider network D1-00029, ranked 29 nationally.
3	RIVERSIDE CARE, INC. Riverside, CA, ranked 1070	$844K	Part of provider network D1-00041, ranked 41 nationally.
3	CARE DIMENSIONS OF THE DESERT, LLC Palm Desert, CA, ranked 1167	$450K	Part of provider network D1-00092, ranked 92 nationally.

All 178 in CA

Recent enforcement in CA

All releases

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

DOJPleaded guiltyAug 27, 2026

Anaheim Woman Pleads Guilty to Submitting More Than $2.2 Million in Fraudulent Hospice Care Claims to Medicare

Galbraith submitted approximately $2,266,694 in claims to Medicare for hospice services for beneficiaries who did not have a terminal illness with a life expectancy of six months or less, and Medicare paid her company approximately $2,140,606.

DOJCivil settlementAug 26, 2026

DermTech Inc. to Pay Up to $5M to Resolve Allegations It Submitted False Claims to Medicare for Unreliable Skin Cancer Tests

DermTech Inc. submitted claims to Medicare for skin cancer tests conducted with an unvalidated positive control range and for tests lacking sufficient patient RNA, and did not retract results or adequately refund Medicare.

DOJCivil settlementAug 26, 2026

DermTech Inc. to Pay Up to $5M to Resolve Allegations It Submitted False Claims to Medicare for Unreliable Skin Cancer Tests

DermTech Inc. billed Medicare for skin cancer tests conducted using an unvalidated positive control range and for tests with insufficient patient RNA, and did not retract the results or adequately refund Medicare.

DOJCivil settlementAug 24, 2026

Medicare Advantage Provider Monogram Health Agrees to Pay $2.4 Million to Settle False Claims Act Lawsuit

Monogram knowingly submitted diagnosis codes in four HCCs that were not clinically accurate, not supported by medical record documentation, and/or did not require or affect patient care, inflating Medicare Advantage beneficiaries' risk scores and causing CMS to make higher capitated payments to Medicare Advantage Organizations.

DOJCivil settlementAug 24, 2026

Medicare Advantage Provider Monogram Health Agrees to Pay $2.4M to Settle False Claims Act Suit

Monogram Health knowingly submitted diagnosis codes within four HCCs that were not clinically accurate, not supported by medical record documentation, and/or did not require or affect patient care, inflating Medicare Advantage beneficiaries' risk scores and causing CMS to make higher capitated payments to MAOs.

Referral packet

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