Providers
SERGIO SAUL CANTU, M.D.
NPI 1770862047, individual, Alice, TX, Family Medicine
4
Evidence tier
structure or single-organization volume
- Hours beyond a day in 5 months under one organization, which can be supervisory billing.
- Records needed.
score 50 of 100, rank 9492, $174K 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 |
|---|---|---|---|---|---|---|---|---|---|
| Jan 2018 | More hours than a day holds at a conservative unit price | 9.8 | 75.4 | 50.3 | 67.7 | 277 | 1 | 99213 99214 99308 99309 99337 | $26K |
| Jan 2019 | More hours than a day holds at a conservative unit price | 7.6 | 47.6 | 31.7 | 42.8 | 251 | 1 | 99214 99308 99309 99336 | $19K |
| Jan 2020 | More hours than a day holds at a conservative unit price | 10.7 | 59.3 | 39.5 | 53.3 | 278 | 1 | 99214 99308 99309 | $25K |
| Jan 2021 | More hours than a day holds at a conservative unit price | 21.8 | 46.5 | 31.0 | 45.7 | 427 | 1 | 99214 99306 99308 99309 99336 99349 99407 | $35K |
| Jan 2022 | More hours than a day holds at a conservative unit price | 15.9 | 36.0 | 24.0 | 35.4 | 320 | 1 | 99214 99306 99308 99309 99407 | $30K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | SERGIO SAUL CANTU, M.D. |
| Type | Individual, sole proprietor |
| Status | Active |
| NPI issued | August 4, 2011, last updated December 12, 2023 |
| Practice location | 779 N TEXAS BLVD, Alice, TX 78332-3883, 361-668-0919 |
| Specialties | Hospitalist (208M00000X, license P0707 TX) Family Medicine (207Q00000X, primary, license P0707 TX) |
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 | |
|---|---|---|---|---|---|---|---|
| T2046 | Medicaid service code | $441K | 51% | $3K | $4K (top 5% from $6K) | 13th percentile | |
| 99309 | Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes | $191K | 22% | $22 | $21 (top 5% from $84) | 52nd percentile | |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $97K | 11% | $22 | $60 (top 5% from $133) | 11th percentile | |
| 99308 | Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more | $43K | 5% | $9.04 | $14 (top 5% from $58) | 31st percentile | |
| 99349 | Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes | $20K | 2% | $45 | $30 (top 5% from $115) | 70th percentile | |
| 99497 | Advance care planning, first 30 minutes | $15K | 2% | $2.65 | $11 (top 5% from $62) | 25th percentile | |
| 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 | $15K | 2% | $2.62 | $13 (top 5% from $40) | 24th percentile | |
| 96372 | Injection of drug or substance under skin or into muscle | $11K | 1% | $10 | $12 (top 5% from $49) | 43rd 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 |
|---|---|---|---|---|---|---|---|---|
| 99309 | Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes | 5,068 | 206 | $391K | $167 | $101 | 1.7x | 2.0x (90th percentile 3.3x) |
| 99497 | Advance care planning, first 30 minutes | 1,285 | 451 | $69K | $120 | $74 | 1.6x | 2.3x (90th percentile 4.9x) |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | 731 | 194 | $59K | $198 | $119 | 1.7x | 2.3x (90th percentile 3.8x) |
| 99308 | Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more | 1,051 | 141 | $56K | $127 | $69 | 1.8x | 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 | 1,303 | 285 | $51K | $122 | $51 | 2.4x | 1.8x (90th percentile 2.9x) |
| 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 | 612 | 95 | $47K | $201 | $98 | 2.0x | 1.6x (90th percentile 2.9x) |
| 99496 | Transitional care management services for problem of high complexity | 167 | 131 | $25K | $310 | $192 | 1.6x | 1.9x (90th percentile 3.1x) |
| 99349 | Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes | 279 | 59 | $23K | $238 | $119 | 2.0x | 2.0x (90th percentile 3.4x) |
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
2 providers in Jim Wells County, TX carry an indicator in the public record, with $109K at stake between them. The most common is part of a provider network, on 2 of them.
| tier | provider | at stake | why |
|---|---|---|---|
| 3 | GARCIA VENTURES, INC. Alice, TX, ranked 1345 | $109K |
|
| 3 | RJ MERIDIAN CARE OF ALICE, LTD Alice, TX, ranked 1704 | $153 |
|
Recent enforcement in TX
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
DOJCivil settlementAug 26, 2026
Dallas medical clinic to pay $7.5 million to resolve COVID-19 testing overbilling allegations
Aymancare billed the federal government's HRSA Uninsured Program for separate evaluation and management services in addition to COVID-19 specimen collection and testing at pop-up testing sites when no such separate services were performed.
DOJConvictedAug 12, 2026
Scammer pharmacist guilty in $20 million healthcare kickback scheme
Thomas paid over $2 million in kickbacks to the owner of a Houston clinic in exchange for referrals of DOL-OWCP insured patients prescribed high-reimbursement compounded medications, which his pharmacy then billed to DOL-OWCP, receiving more than $20 million in reimbursements.
DOJIndictedJun 24, 2026
U.S. Attorney Announces Major Health Care Fraud Cases in Western District of Texas
Charles is alleged to have received illegal kickbacks for referring patients to San Antonio area hospice companies, causing over $9 million in Medicare claims, while Dr. Duncan settled allegations of billing Medicare and TRICARE for an unapproved amniotic-based product and Trevor's Place settled allegations of submitting inflated TRICARE claims for services not provided.
DOJIndictedJun 23, 2026
Nine charged in SDTX as part of national health care fraud takedown
Nine defendants were indicted in the Southern District of Texas for operating pill mill clinics and a pharmacy that unlawfully distributed controlled substances, billing Medicaid $16 million for mental health services for minors that did not occur, and billing Medicare and TRICARE approximately $906 million for medically unnecessary amniotic wound allografts procured through kickbacks.
DOJChargedJun 23, 2026
Northern District of Texas Charges 13 Health Care Fraudsters for Loss Over $360 Million
Thirteen defendants in the Northern District of Texas were charged in seven cases involving more than $365 million in fraudulent billing to federally-funded programs and other insurers, including laboratory and genetic testing claims procured through kickbacks, transcranial magnetic stimulation treatments billed to TRICARE, medically unnecessary EEG testing, and hospice services never provided.
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.