Providers
ENGIDA B ALEMU, MD
NPI 1710916705, individual, Yuma, AZ, Specialist
4
Evidence tier
structure or single-organization volume
- Hours beyond a day in 1 month under one organization, which can be supervisory billing.
- Records needed.
- Medicaid dollars per patient on code 99233 ($268 per patient-month) sit in the top 5% of every provider billing that code.
score 55 of 100, rank 7987, $331K 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 |
|---|---|---|---|---|---|---|---|---|---|
| Dec 2020 | More hours than a day holds, even counting one unit per claim line | 24.6 | 23.2 | 15.5 | 20.8 | 286 | 1 | 99223 99232 99233 99442 | $50K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | ENGIDA B ALEMU, MD |
| Type | Individual, sole proprietor |
| Status | Active |
| NPI issued | July 2, 2006, last updated July 28, 2014 |
| Practice location | 2281 W 24TH ST, SUITE 11, Yuma, AZ 85364, 928-314-3201 |
| Specialties | Specialist (174400000X, primary, license 37473 AZ) |
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 | |
|---|---|---|---|---|---|---|---|
| 99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | $1.3M | 61% | $268 | $96 (top 5% from $249) | 96th percentile | |
| 99254 | Medicaid service code | $447K | 21% | $140 | $90 (top 5% from $178) | 85th percentile | |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $176K | 8% | $63 | $60 (top 5% from $133) | 54th percentile | |
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | $85K | 4% | $55 | $67 (top 5% from $174) | 37th percentile | |
| 99442 | Telephone medical discussion with physician, 11-20 minutes | $58K | 3% | $54 | $21 (top 5% from $104) | 78th percentile | |
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | $45K | 2% | $26 | $81 (top 5% from $170) | 4th percentile | |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | $3K | 0% | $54 | $44 (top 5% from $110) | too few months to rank | |
| 99222 | Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes | $2K | 0% | $35 | $63 (top 5% from $137) | 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 |
|---|---|---|---|---|---|---|---|---|
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | 1,410 | 372 | $85K | $150 | $76 | 2.0x | 2.6x (90th percentile 4.3x) |
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | 590 | 495 | $78K | $350 | $166 | 2.1x | 3.0x (90th percentile 5.6x) |
| 99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | 603 | 263 | $55K | $180 | $114 | 1.6x | 2.6x (90th percentile 4.7x) |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | 449 | 242 | $43K | $150 | $124 | 1.2x | 2.3x (90th percentile 3.8x) |
| 99204 | New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more | 82 | 82 | $10K | $220 | $162 | 1.4x | 2.4x (90th percentile 3.9x) |
| 99222 | Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes | 20 | 20 | $2K | $220 | $124 | 1.8x | 2.7x (90th percentile 4.4x) |
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
6 providers in Yuma County, AZ carry an indicator in the public record, with $13.7M at stake between them. The most common is more hours than a day holds, on 6 of them.
| tier | provider | at stake | why |
|---|---|---|---|
| 4 | MALLAPPA NEELAPPA Yuma, AZ, ranked 8585 | $2.8M |
|
| 4 | CARL MALMQUIST Yuma, AZ, ranked 8806 | $1.6M |
|
| 4 | REBECCA DOWNS Yuma, AZ, ranked 8987 | $993K |
|
| 5 | OLIVIA WILSON Yuma, AZ, ranked 10101 | $1.1M |
|
| 5 | SERGIO MACIAS San Luis, AZ, ranked 10692 | $5.0M | |
| 5 | MARIA MACIAS San Luis, AZ, ranked 10793 | $2.2M |
Recent enforcement in AZ
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
DOJChargedJun 23, 2026
District of Arizona Announces Charges Involving Over $1.2 Billion in False or Fraudulent Claims as Part of National Health Care Fraud Takedown
Four defendants were charged in connection with alleged schemes involving over $1.2 billion in false or fraudulent claims for amniotic wound allografts procured through kickbacks and for substance abuse treatment services billed to Arizona Medicaid that were not provided as billed.
DOJSentencedJun 4, 2026
New River Couple Sentenced for $12 Million AHCCCS Fraud Scheme
The Currys submitted a fraudulent AHCCCS provider enrollment application concealing Thvoughn Curry's ownership role and then billed AHCCCS through 1 Family Clinic, LLC for behavioral health and substance abuse therapy services that were not provided, receiving more than $12 million.
DOJCivil settlementMar 12, 2026
Arizona Cardiology Group to Pay $4.75M to Resolve Allegations of Unnecessary Vein Ablations
Tri-City Cardiology and three physicians allegedly violated the False Claims Act by performing medically unnecessary ablations on perforator veins and incorrectly measuring or documenting blood flow duration, vein diameter, patient symptoms, and conservative therapy measures to make the procedures appear justified.
DOJConvictedFeb 27, 2026
New River Couple Convicted of $12 Million AHCCCS Fraud Scheme
The Currys submitted a fraudulent AHCCCS provider enrollment application concealing Thvoughn Curry's ownership and then billed AHCCCS for behavioral health services that were not actually provided through 1 Family Clinic, LLC, receiving more than $12 million.
DOJSentencedFeb 27, 2026
Mesa Residents Sentenced to Prison for Fraud Targeting AHCCCS
Riley and Gooch, through their behavioral health clinic New Horizons Behavioral Health, exploited AHCCCS's American Indian Health Program between 2020 and 2022 by falsely billing for services that were not provided, obtaining approximately $3.3 million.
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.