Providers
KAREN RUPERTO-RIVERA, MD
NPI 1861409781, individual, Ponce, PR, General Practice
5
Evidence tier
informational
score 30 of 100, rank 11502, $169K at stake
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | KAREN RUPERTO-RIVERA, MD |
| Type | Individual, sole proprietor |
| Status | Active |
| NPI issued | August 2, 2006, last updated December 12, 2013 |
| Practice location | 396 CALLE DR LUIS SALAS URB INSDUSTRIAL REPARADA, ESCUELA DE MEDICINA DE PONCE, Ponce, PR 00732, 787-840-2575 |
| Mailing address | PO BOX 7004, Ponce, PR 00732-7004 |
| Specialties | General Practice (208D00000X, primary, license 15501 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 | |
|---|---|---|---|---|---|---|---|
| 99441 | Telephone medical discussion with physician, 5-10 minutes | $260K | 47% | $59 | $11 (top 5% from $106) | 91st percentile | |
| 99212 | Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more | $153K | 28% | $42 | $28 (top 5% from $147) | 74th percentile | |
| 99442 | Telephone medical discussion with physician, 11-20 minutes | $101K | 18% | $95 | $21 (top 5% from $104) | 94th percentile | |
| 99284 | Emergency department visit with moderate level of medical decision making | $28K | 5% | $121 | $86 (top 5% from $224) | 76th percentile | |
| 99211 | Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional | $13K | 2% | $43 | $16 (top 5% from $128) | too few months to rank | |
| 96127 | Assessment of emotional or behavioral problems | $48 | 0% | $3.96 | $4.12 (top 5% from $19) | too few months to rank |
In this area
8 providers in Ponce, PR carry an indicator in the public record, with $9.0M 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 1.
| tier | provider | at stake | why |
|---|---|---|---|
| 3 | CMS HOME CARE SUR, LLC. Ponce, PR, ranked 5147 | $0 |
|
| 4 | ANTONIA NIEVES SANCHEZ Ponce, PR, ranked 8263 | $186K |
|
| 4 | DAISY COSTAS VARGAS Ponce, PR, ranked 8326 | $7.7M |
|
| 4 | SHAIRA LOPEZ ACEVEDO Ponce, PR, ranked 9129 | $634K |
|
| 4 | NATALIA DIEPPA LOPEZ DE VICTORIA Ponce, PR, ranked 9530 | $138K |
|
| 5 | JOMAYRA NEGRON BANKS Ponce, PR, ranked 10706 | $40K |
|
| 5 | AXEL REYES VAZQUEZ Ponce, PR, ranked 10752 | $27K |
|
| 5 | LUIS LOPEZ DEL POZO Ponce, PR, ranked 11476 | $191K |
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.