Providers
All 15 in RI
MIRIANNYS RIVAS, FNP-C
NPI 1790240141, individual, Providence, RI, Nurse Practitioner, Family
4
Evidence tier
structure or single-organization volume
- Hours beyond a day in 2 months, but with up to 695 patients a month, which points to a supervising clinician on the claims rather than one person's hours.
- Records needed.
- Medicaid dollars per patient on code 99204 ($293 per patient-month) sit in the top 5% of every provider billing that code.
score 55 of 100, rank 7811, $1.1M 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 |
|---|---|---|---|---|---|---|---|---|---|
| Nov 2020 | More hours than a day holds, even counting one unit per claim line | 26.5 | 31.0 | 20.7 | 29.6 | 415 | 2 | 99203 99204 99212 99213 99214 | $131K |
| Dec 2020 | More hours than a day holds, even counting one unit per claim line | 35.2 | 41.8 | 27.9 | 37.6 | 499 | 2 | 99203 99204 99213 99214 | $177K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | MIRIANNYS RIVAS, FNP-C |
| Type | Individual |
| Status | Active |
| NPI issued | February 8, 2019, last updated March 18, 2024 |
| Practice location | 655 BROAD ST STE 201, Providence, RI 02907-1444, 401-390-0734 |
| Specialties | Nurse Practitioner, Family (363LF0000X, primary, license APRN02001 RI) |
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 | |
|---|---|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $1.3M | 57% | $114 | $60 (top 5% from $133) | 91st percentile | |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | $356K | 15% | $122 | $44 (top 5% from $110) | 96th percentile | |
| 99204 | New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more | $265K | 11% | $293 | $95 (top 5% from $171) | 100th percentile | |
| 99396 | Medicaid service code | $78K | 3% | $75 | $70 (top 5% from $132) | 54th percentile | |
| 99203 | New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more | $77K | 3% | $242 | $67 (top 5% from $121) | too few months to rank | |
| 87635 | Amplifed dna or rna probe detection of severe acute respiratory syndrome coronavirus 2 (covid-19) antigen | $53K | 2% | $135 | $44 (top 5% from $70) | 99th percentile | |
| 99409 | Alcohol/substance screening and brief intervention more than 30 min | $30K | 1% | $33 | $30 (top 5% from $156) | 54th percentile | |
| 93000 | Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report | $24K | 1% | $21 | $11 (top 5% from $25) | 91st 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 |
|---|---|---|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | 134 | 61 | $8K | $180 | $109 | 1.7x | 2.3x (90th percentile 3.8x) |
| 99215 | Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more | 14 | 12 | $1K | $200 | $155 | 1.3x | 2.4x (90th percentile 4.1x) |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | 17 | 16 | $948 | $130 | $78 | 1.7x | 2.2x (90th percentile 3.8x) |
| 93000 | Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report | 13 | 13 | $88 | $75 | $12 | 6.1x | 4.2x (90th percentile 7.7x) |
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
15 providers in Providence County, RI carry an indicator in the public record, with $28.5M at stake between them. The most common is more hours than a day holds, on 7 of them, followed by part of a provider network on 6. 1 is tier 1: documented action, then payment.
| tier | provider | at stake | why |
|---|---|---|---|
| 1 | CARE CENTER RHODE ISLAND LLC East Providence, RI, ranked 100 | $270K |
|
| 3 | BEACON HOSPICE, LLC East Providence, RI, ranked 989 | $1.7M |
|
| 3 | CORTLAND PLACE REHAB CENTER LLC Greenville, RI, ranked 1385 | $75K |
|
| 3 | OVERLOOK EDEN OPERATIONS, LLC Pascoag, RI, ranked 3154 | $0 |
|
| 3 | VIOLET SNF HOLDCO LLC Pawtucket, RI, ranked 4230 | $0 |
|
| 3 | CL OPERATING LLC Pascoag, RI, ranked 4389 | $0 |
|
| 3 | FRIENDLY EDEN OPERATIONS LLC Woonsocket, RI, ranked 7098 | $0 |
|
| 4 | CATHERINE ALLEN Providence, RI, ranked 7285 | $7.2M |
|
Recent enforcement in RI
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
DOJIndictedJun 24, 2026
Two Charged in District of Rhode Island as Part of National Fraud Takedown
Two defendants were charged by indictment with using the identity of another person to obtain benefits, including approximately $28,236.42 and $24,018.86 in Rhode Island Medicaid benefits.
DOJOtherFeb 17, 2026
Zynex, Inc. Agrees to Criminal Resolution Addressing Claims of Millions of Dollars of Health Care Fraud, Securities Fraud and Related Offenses
Zynex admitted to submitting excessive and improper claims for medical devices and supplies, including medically unnecessary electrode supplies in excess quantities, to government and private health care payors and patients, and to concealing from investors that its revenues were driven by fraudulent billing.
DOJIndictedJan 21, 2026
Former Zynex, Inc. Executives Charged with Health Care and Securities Fraud and Related Offenses
The indictment alleges that from at least 2017 through late 2025 the former CEO and COO of Zynex, Inc. caused the company to submit fraudulent billings to government and private health care payors and patients for medical devices and supplies that were not medically necessary, not covered, and not agreed to by patients, and used those billings to inflate the company's financial reporting and stock price.
DOJIndictedApr 7, 2025
Pain Management Clinic Owners and Operators Indicted on Health Care Fraud Charges
The owners and operators of a pain management clinic allegedly submitted fraudulent claims to Medicare, Medicare Advantage, Medicaid Managed Care, and four private insurers for purportedly medically necessary services, including acupuncture, physical therapy, and office visits, that were not actually provided to patients, in order to collect payment for massage therapy and other services not provided.
DOJSentencedMar 5, 2025
Addiction Treatment Center Supervisor Sentenced in Scheme to Defraud Federal, State, and Private Health Care Insurers
A clinical social worker supervisor at an addiction treatment center devised and executed a scheme to submit false claims for 45-minute psychotherapy and counseling sessions that lasted only 5-10 minutes or did not occur as billed, defrauding Medicare, Medicaid, and other health insurers of more than $3.5 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.