Providers
All 81 in PR
MARIA CRISTINA RIVERA CRUZ
NPI 1851696199, individual, Carolina, PR, Occupational Therapist
4
Evidence tier
structure or single-organization volume
- Hours beyond a day in 4 months, but with up to 521 patients a month across 3 billing organizations, which points to a supervising clinician on the claims rather than one person's hours.
- Records needed.
score 51 of 100, rank 8544, $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 |
|---|---|---|---|---|---|---|---|---|---|
| Jan 2023 | More hours than a day holds, even counting one unit per claim line | 27.8 | 23.6 | 15.7 | 22.1 | 358 | 2 | 97129 97530 97533 97535 | $120K |
| Oct 2023 | More hours than a day holds, even counting one unit per claim line | 24.7 | 24.0 | 16.0 | 22.5 | 473 | 1 | 97129 97530 97533 97535 | $124K |
| Oct 2024 | More hours than a day holds, even counting one unit per claim line | 33.3 | 28.3 | 18.8 | 25.4 | 521 | 1 | 97129 97530 97533 | $167K |
| Nov 2024 | More hours than a day holds, even counting one unit per claim line | 30.8 | 29.0 | 19.4 | 27.6 | 403 | 1 | 97530 97533 | $162K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | MARIA CRISTINA RIVERA CRUZ |
| Type | Individual, sole proprietor |
| Status | Active |
| NPI issued | January 18, 2011, last updated August 3, 2026 |
| Practice location | VILLA CAROLINA, AVE ROBERTO CLEMENTE BLK 27-16, Carolina, PR 00985, 787-276-8123 |
| Mailing address | PO BOX 2963, Carolina, PR 00984-2963 |
| Specialties | Occupational Therapist (225X00000X, primary, license 1083 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 | |
|---|---|---|---|---|---|---|---|
| 97533 | Therapy procedure using sensory experiences | $3.2M | 62% | $234 | $151 (top 5% from $556) | 74th percentile | |
| 97530 | Therapy procedure using functional activities | $1.4M | 28% | $197 | $124 (top 5% from $387) | 68th percentile | |
| 97535 | Training for self-care or home management, each 15 minutes | $246K | 5% | $171 | $48 (top 5% from $459) | 76th percentile | |
| 97129 | Therapy procedure for a range of mental processes, initial 15 minutes | $94K | 2% | $68 | $54 (top 5% from $375) | 60th percentile | |
| 97167 | Evaluation for occupational therapy, typically 1 hour | $81K | 2% | $64 | $63 (top 5% from $227) | 53rd percentile | |
| 97130 | Therapy procedure for a range of mental processes, each additional 15 minutes | $57K | 1% | $99 | $87 (top 5% from $641) | 52nd percentile | |
| 97112 | Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes | $52K | 1% | $124 | $59 (top 5% from $187) | 88th percentile | |
| 99442 | Telephone medical discussion with physician, 11-20 minutes | $10K | 0% | $73 | $21 (top 5% from $104) | 88th percentile |
In this area
81 providers in PR carry an indicator in the public record, with $49.7M at stake between them. The most common is more hours than a day holds, on 70 of them, followed by part of a provider network on 5. 6 are tier 1: documented action, then payment.
| tier | provider | at stake | why |
|---|---|---|---|
| 1 | MELVIN MATHEWS BERMUDEZ Manati, PR, ranked 119 | $166K |
|
| 1 | PHYSICIAN H.M.O. INC. San Juan, PR, ranked 158 | $81K |
|
| 1 | DIANA GALLARDO Caguas, PR, ranked 321 | $5K |
|
| 1 | VILLALBA MEDICAL TRANSPORT LLC Juana Diaz, PR, ranked 401 | $909 |
|
| 1 | PHYSICIAN HMO INC. San Juan, PR, ranked 408 | $680 |
|
| 1 | PHYSICIAN HMO INC. Rio Piedras, PR, ranked 460 | $0 |
|
| 2 | YAMIR GARCIA SEGARRA Caguas, PR, ranked 696 | $1.9M |
|
| 3 | CMS HOME CARE NORTE, LLC Hatillo, PR, ranked 3502 | $0 |
|
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.