Providers
All 16 in TX
MICHAEL ANTHONY HERNANDEZ, MD
NPI 1851380885, individual, Corpus Christi, TX, Psychiatry & Neurology, Psychiatry
4
Evidence tier
structure or single-organization volume
- Hours beyond a day in 21 months under one organization, which can be supervisory billing.
- Records needed.
- Medicaid dollars per patient on code 90853 ($3114 per patient-month) sit in the top 5% of every provider billing that code.
- 81% of Medicaid dollars are on codes with a history of abuse.
score 57 of 100, rank 7296, $3.1M 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 |
|---|---|---|---|---|---|---|---|---|---|
| May 2021 | More hours than a day holds at a conservative unit price | 3.7 | 44.0 | 29.3 | 43.3 | 58 | 2 | 90853 99233 99238 | $93K |
| Jul 2021 | More hours than a day holds at a conservative unit price | 3.0 | 39.1 | 26.1 | 36.7 | 77 | 2 | 90853 99222 99231 99233 99239 | $84K |
| Sep 2021 | More hours than a day holds at a conservative unit price | 3.8 | 39.4 | 26.3 | 35.8 | 89 | 2 | 90853 99222 99231 99238 99239 | $82K |
| Oct 2021 | More hours than a day holds at a conservative unit price | 3.9 | 48.5 | 32.3 | 47.7 | 86 | 2 | 90853 99222 99231 99239 | $105K |
| Nov 2021 | More hours than a day holds at a conservative unit price | 2.9 | 45.4 | 30.3 | 41.3 | 54 | 2 | 90853 99222 99231 99239 | $95K |
| Mar 2022 | More hours than a day holds at a conservative unit price | 4.8 | 68.5 | 45.7 | 61.6 | 98 | 2 | 90853 99222 99231 99239 | $133K |
| Apr 2022 | More hours than a day holds at a conservative unit price | 4.7 | 56.0 | 37.3 | 53.3 | 105 | 2 | 90792 90853 99231 99239 | $107K |
| May 2022 | More hours than a day holds at a conservative unit price | 6.0 | 56.4 | 37.6 | 53.0 | 131 | 2 | 90792 90853 99231 99239 | $112K |
| Sep 2022 | More hours than a day holds at a conservative unit price | 5.2 | 39.1 | 26.1 | 35.5 | 132 | 2 | 90853 99222 99231 99232 99239 | $75K |
| Oct 2022 | More hours than a day holds at a conservative unit price | 5.4 | 65.5 | 43.6 | 64.4 | 118 | 2 | 90853 99222 99231 99232 99239 | $128K |
| Nov 2022 | More hours than a day holds at a conservative unit price | 4.4 | 43.0 | 28.6 | 39.0 | 102 | 2 | 90853 99222 99231 99239 | $82K |
| Dec 2022 | More hours than a day holds at a conservative unit price | 3.3 | 42.6 | 28.4 | 40.1 | 77 | 2 | 90853 99222 99231 99239 | $83K |
| Feb 2023 | More hours than a day holds at a conservative unit price | 3.7 | 60.0 | 40.0 | 56.0 | 81 | 2 | 90792 90853 99222 99231 99239 | $106K |
| Mar 2023 | More hours than a day holds at a conservative unit price | 6.0 | 84.6 | 56.4 | 76.0 | 154 | 2 | 90792 90853 99222 99231 99232 99239 | $166K |
| Apr 2023 | More hours than a day holds at a conservative unit price | 3.8 | 41.7 | 27.8 | 41.7 | 97 | 2 | 90792 90853 99222 99231 99239 | $80K |
| May 2023 | More hours than a day holds at a conservative unit price | 3.4 | 38.6 | 25.7 | 34.7 | 97 | 2 | 90792 90853 99222 99231 99232 99239 | $76K |
| Oct 2023 | More hours than a day holds at a conservative unit price | 4.4 | 61.9 | 41.2 | 58.1 | 93 | 2 | 90792 90853 99222 99231 99232 99239 | $121K |
| Nov 2023 | More hours than a day holds at a conservative unit price | 2.1 | 41.0 | 27.3 | 37.3 | 40 | 2 | 90792 90853 99222 99231 99232 99239 | $77K |
| Feb 2024 | More hours than a day holds at a conservative unit price | 1.9 | 56.1 | 37.4 | 51.7 | 31 | 1 | 90792 90853 99222 99231 99232 99239 | $101K |
| Mar 2024 | More hours than a day holds at a conservative unit price | 1.2 | 37.3 | 24.9 | 36.7 | 22 | 1 | 90792 90853 99222 99231 99232 99239 | $72K |
| Nov 2024 | More hours than a day holds at a conservative unit price | 1.8 | 42.9 | 28.6 | 40.9 | 23 | 1 | 90792 90853 99222 99231 99232 99239 | $80K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | MICHAEL ANTHONY HERNANDEZ, MD |
| Type | Individual, sole proprietor |
| Status | Active |
| NPI issued | October 21, 2005, last updated January 27, 2021 |
| Practice location | 5440 OLD BROWNSVILLE RD, Corpus Christi, TX 78417-9765, 361-906-0166 |
| Specialties | Psychiatry & Neurology, Psychiatry (2084P0800X, primary, license L6426 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 | |
|---|---|---|---|---|---|---|---|
| 90853 | Group psychotherapyhistory of abuse | $3.0M | 81% | $3K | $60 (top 5% from $332) | 100th percentile | |
| 99231 | Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes | $228K | 6% | $92 | $37 (top 5% from $103) | 93rd percentile | |
| 99222 | Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes | $146K | 4% | $99 | $63 (top 5% from $137) | 82nd percentile | |
| 99239 | Hospital discharge day management, more than 30 minutes | $131K | 4% | $80 | $49 (top 5% from $101) | 86th percentile | |
| 90792 | Psychiatric diagnostic evaluation with medical services | $118K | 3% | $126 | $112 (top 5% from $313) | 59th percentile | |
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | $64K | 2% | $86 | $67 (top 5% from $174) | 67th percentile | |
| 99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | $19K | 1% | $114 | $96 (top 5% from $249) | too few months to rank | |
| 99238 | Hospital discharge day management, 30 minutes or less | $4K | 0% | $51 | $48 (top 5% from $80) | 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 |
|---|---|---|---|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | 18 | 17 | $691 | $125 | $87 | 1.4x | 2.2x (90th percentile 3.8x) |
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
16 providers in Nueces County, TX carry an indicator in the public record, with $17.6M at stake between them. The most common is more hours than a day holds, on 8 of them, followed by part of a provider network on 7. 1 is tier 1: documented action, then payment.
| tier | provider | at stake | why |
|---|---|---|---|
| 1 | RAUL CAPITAINE Corpus Christi, TX, ranked 303 | $8K |
|
| 3 | HUB CITY HOME HEALTH INC Corpus Christi, TX, ranked 817 | $9.3M |
|
| 3 | REHMET HOLDINGS LLC Corpus Christi, TX, ranked 2967 | $0 |
|
| 3 | APC HOME HEALTH SERVICE, INC. Corpus Christi, TX, ranked 5377 | $0 |
|
| 3 | CIMA HOSPICE OF CORPUS CHRISTI, LLC Corpus Christi, TX, ranked 6503 | $0 |
|
| 3 | TRIO HOME HEALTH INC, Corpus Christi, TX, ranked 6549 | $0 |
|
| 3 | CORPUS CHRISTI HOME CARE, INC. Corpus Christi, TX, ranked 6611 | $0 |
|
| 3 | TRIO HOSPICE INC Corpus Christi, TX, ranked 7111 | $0 |
|
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.