Providers
All 12 in PR
FRANKIE ALVARADO, M.D.
NPI 1730219098, individual, San Juan, PR, Internal Medicine, Pulmonary Disease
4
Evidence tier
structure or single-organization volume
- Hours beyond a day in 3 months under one organization, which can be supervisory billing.
- Records needed.
- Medicaid dollars per patient on code 99291 ($878 per patient-month) sit in the top 5% of every provider billing that code.
score 55 of 100, rank 7831, $1.0M 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 |
|---|---|---|---|---|---|---|---|---|---|
| Sep 2020 | More hours than a day holds, even counting one unit per claim line | 29.6 | 41.4 | 27.6 | 37.6 | 289 | 1 | 99213 99223 99233 | $81K |
| Nov 2020 | More hours than a day holds, even counting one unit per claim line | 25.2 | 33.6 | 22.4 | 32.0 | 291 | 1 | 99213 99223 99233 | $64K |
| Apr 2021 | More hours than a day holds, even counting one unit per claim line | 27.2 | 25.5 | 17.0 | 23.2 | 353 | 1 | 99213 99223 99233 99291 | $105K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | FRANKIE ALVARADO, M.D. |
| Type | Individual, sole proprietor |
| Status | Active |
| NPI issued | March 6, 2007, last updated March 1, 2012 |
| Practice location | 400 AVE FD ROOSEVELT, SUITE 205 CLINICA LAS AMERICAS, San Juan, PR 00918-2103, 787-765-1919 |
| Specialties | Internal Medicine, Pulmonary Disease (207RP1001X, primary, license 16761 PR) |
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 | |
|---|---|---|---|---|---|---|---|
| 99291 | Critical care, first 30-74 minutes | $1.2M | 45% | $878 | $175 (top 5% from $536) | 99th percentile | |
| 99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | $589K | 22% | $266 | $96 (top 5% from $249) | 96th percentile | |
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | $479K | 18% | $152 | $81 (top 5% from $170) | 92nd percentile | |
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | $103K | 4% | $92 | $67 (top 5% from $174) | 72nd percentile | |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | $103K | 4% | $52 | $44 (top 5% from $110) | 61st percentile | |
| 99253 | Medicaid service code | $86K | 3% | $47 | $60 (top 5% from $116) | 29th percentile | |
| 99203 | New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more | $54K | 2% | $72 | $67 (top 5% from $121) | 57th percentile | |
| 99252 | Medicaid service code | $27K | 1% | $42 | $44 (top 5% from $94) | 46th percentile |
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 |
|---|---|---|---|---|---|---|---|---|
| 99291 | Critical care, first 30-74 minutes | 70 | 17 | $12K | $285 | $206 | 1.4x | 4.7x (90th percentile 10.0x) |
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | 19 | 19 | $2K | $207 | $168 | 1.2x | 3.0x (90th percentile 5.6x) |
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
12 providers in San Juan Municipio County, PR carry an indicator in the public record, with $4.1M at stake between them. The most common is more hours than a day holds, on 8 of them, followed by named in an enforcement record on 3. 3 are tier 1: documented action, then payment.
| tier | provider | at stake | why |
|---|---|---|---|
| 1 | PHYSICIAN H.M.O. INC. San Juan, PR, ranked 158 | $81K |
|
| 1 | PHYSICIAN HMO INC. San Juan, PR, ranked 408 | $680 |
|
| 1 | PHYSICIAN HMO INC. Rio Piedras, PR, ranked 460 | $0 |
|
| 3 | CMS HOME CARE METRO, LLC. San Juan, PR, ranked 5251 | $0 |
|
| 4 | JAN RODRIGUEZ FERRER San Juan, PR, ranked 7946 | $483K |
|
| 4 | ARNALDO CRUZ IGARTUA San Juan, PR, ranked 8890 | $1.3M |
|
| 4 | WALESKA LIND San Juan, PR, ranked 9521 | $144K |
|
| 5 | UBALDO SANTIAGO BUONO San Juan, PR, ranked 10108 | $996K |
|
Recent enforcement in PR
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
DOJIndictedJun 23, 2026
2026 National Health Care Fraud Takedown
Four defendants were charged in two schemes, one involving the advertising, sale, and distribution of Semaglutide, Mounjaro, steroids, and Tirzepatide that defendants were not authorized to possess and distribute, and the other involving performing dental procedures on patients without a valid dental license and misbranding of devices.
DOJCivil settlementJun 4, 2026
Puerto Rico Pharmacies Agree to Pay $4.6 Million to Federal Authorities in Medicare and Medicaid Fraud Cases
Four pharmacies and their owners agreed to pay $4.6 million to resolve allegations that between January 2021 and January 2024 they billed Medicare and Medicaid for diverted prescriptions sold to patients that had been misrepresented as properly sourced despite unverifiable origins.
DOJPleaded guiltyJul 17, 2025
Physician Assistant who Pretended to be a Licensed Physician Pleads Guilty to Making False Statements to an Agency of the United States
Villalobos-Meléndez, a licensed physician assistant who was never licensed to practice medicine, forged medical license and USMLE documents, worked as a physician in a hospital internship program, and submitted false license information on a CMS-855I form seeking enrollment as a Medicare physician provider with benefits reassigned to Physician HMO.
DOJCivil settlementDec 23, 2024
MMM Holdings, LLC Agrees to Pay 15.2 Million Dollars to Resolve Allegations that it Violated the False Claims Act and Anti-Kickback Statute
MMM Holdings distributed gift cards to administrative assistants of providers to induce the referral, recommendation, or arrangement for enrollment of thousands of Medicare beneficiaries in an MMM Medicare Advantage plan and submitted or caused claims for payment to Medicare.
DOJIndictedSep 25, 2024
27 Individuals Indicted for Buying and Selling Wholesale Quantities of Misbranded and Diverted Prescription Drugs Resold to the Public Through Retail Pharmacies in Puerto Rico
Defendants engaged in unlicensed wholesale distribution of misbranded and diverted prescription drugs sold to pharmacy owners and employees who resold them to customers and billed health care benefit plans as if the drugs were authentic and obtained through licensed distribution channels.
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.