Providers
All 11 in CA
RALPH EDWARD RETHERFORD, M.D.
NPI 1801043799, individual, Sonora, CA, Family Medicine
5
Evidence tier
informational
- Medicaid dollars per patient on code 99214 ($450 per patient-month) sit in the top 5% of every provider billing that code.
score 35 of 100, rank 10327, $359K at stake
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | RALPH EDWARD RETHERFORD, M.D. |
| Type | Individual, sole proprietor |
| Status | Active |
| NPI issued | August 21, 2008, last updated August 18, 2016 |
| Practice location | 20405 LYONS BALD MTN RD, Sonora, CA 95370-8780, 209-588-1424 |
| Mailing address | PO BOX 4990, Sonora, CA 95370-1990 |
| Specialties | Family Medicine (207Q00000X, primary, license A24305 CA) Family Medicine, Adolescent Medicine (207QA0000X, license A24305 CA) Family Medicine, Addiction Medicine (207QA0401X, license A24305 CA) Family Medicine, Adult Medicine (207QA0505X, license A24305 CA) General Practice (208D00000X, license A24305 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 | |
|---|---|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $213K | 34% | $450 | $60 (top 5% from $133) | 100th percentile | |
| T1015 | Medicaid service code | $205K | 33% | $147 | $182 (top 5% from $488) | 36th percentile | |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | $195K | 32% | $107 | $44 (top 5% from $110) | 95th percentile | |
| 80305 | Testing for presence of drug, read by direct observation | $5K | 1% | $11 | $9.23 (top 5% from $22) | 64th percentile | |
| 99212 | Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more | $883 | 0% | $19 | $28 (top 5% from $147) | too few months to rank | |
| 90688 | Influenza vaccine, quadrivalent, 0.5 ml dosage | $427 | 0% | $7.00 | $5.67 (top 5% from $19) | too few months to rank | |
| 1160F | Medicaid service code | $0 | 0% | $0.00 | $0.00 (top 5% from $0.09) | too few months to rank | |
| 3008F | Medicaid service code | $0 | 0% | $0.00 | $0.00 (top 5% from $1.17) | too few months to rank |
In this area
11 providers in Tuolumne County, CA carry an indicator in the public record, with $3.8M 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 3. 1 is tier 1: documented action, then payment.
| tier | provider | at stake | why |
|---|---|---|---|
| 1 | ADULT MEDICINE SPECIALISTS, INC Sonora, CA, ranked 369 | $2K |
|
| 3 | WESTERN HEALTH RESOURCES Sonora, CA, ranked 1436 | $43K |
|
| 3 | SONORA COMMUNITY HOSPITAL Sonora, CA, ranked 3082 | $0 |
|
| 3 | WESTERN HEALTH RESOURCES Sonora, CA, ranked 6493 | $0 |
|
| 4 | ROBERT REINA Sonora, CA, ranked 7656 | $2.2M |
|
| 4 | HAKU KAHOANO Jamestown, CA, ranked 8007 | $264K |
|
| 4 | RANDOLPH ROXAS Tuolumne, CA, ranked 8015 | $231K |
|
| 5 | ALEJANDRO ABARCA Sonora, CA, ranked 10373 | $231K |
|
Recent enforcement in CA
All releasesDepartment 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
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.