Providers
All 22 in CA
ROY SCHINDELHEIM, M.D.
NPI 1871579599, individual, King City, CA, Family Medicine
1
Evidence tier
documented action, then payment
- Listed on the CA Medicaid exclusion list since June 21, 2022.
- Medicaid still paid claims in 2 later months, $10,910 in total.
- Medicaid dollars per patient on code 92551 ($20 per patient-month) sit in the top 5% of every provider billing that code.
score 98 of 100, rank 26, $11K at stake
Paid after the action
Months in which Medicaid paid claims for this provider after a public action that should have triggered a screening check. This is a record of payments, not a determination that they were improper.
| list | identity check | action date | window closed | months paid after | first | last | paid after | 12 months before |
|---|---|---|---|---|---|---|---|---|
| CA Medicaid exclusion list ca medi-cal suspended & ineligible provider list (july 2026) | Exact NPI, name verified | Jun 21, 2022 | still open | 2 | Nov 2024 | Dec 2024 | $11K | $0 |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | ROY SCHINDELHEIM, M.D. |
| Type | Individual |
| Status | Active |
| NPI issued | December 15, 2005, last updated July 13, 2026 |
| Practice location | 210 CANAL ST, King City, CA 93930-3432, 831-385-7157 |
| Specialties | Family Medicine (207Q00000X, primary, license C37325 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 | |
|---|---|---|---|---|---|---|---|
| T1015 | Medicaid service code | $2.2M | 85% | $210 | $182 (top 5% from $488) | 62nd percentile | |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | $125K | 5% | $24 | $44 (top 5% from $110) | 20th percentile | |
| 99212 | Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more | $72K | 3% | $19 | $28 (top 5% from $147) | 33rd percentile | |
| 99393 | Medicaid service code | $35K | 1% | $85 | $78 (top 5% from $121) | 62nd percentile | |
| 92551 | Medicaid service code | $29K | 1% | $20 | $4.76 (top 5% from $18) | 96th percentile | |
| 99392 | Medicaid service code | $25K | 1% | $72 | $78 (top 5% from $124) | 41st percentile | |
| 99394 | Medicaid service code | $21K | 1% | $106 | $83 (top 5% from $128) | 81st percentile | |
| 87880 | Detection test by immunoassay with direct visual observation for streptococcus, group a (strep) | $14K | 1% | $9.26 | $12 (top 5% from $18) | 31st percentile |
In this area
22 providers in Monterey County, CA carry an indicator in the public record, with $19.2M at stake between them. The most common is more hours than a day holds, on 13 of them, followed by part of a provider network on 8.
| tier | provider | at stake | why |
|---|---|---|---|
| 3 | SUTTER VISITING NURSE ASSOCIATION AND HOSPICE Salinas, CA, ranked 1353 | $103K |
|
| 3 | MARJORAM HOLDINGS, LLC Monterey, CA, ranked 2556 | $0 |
|
| 3 | ADOBE HOME HEALTH, INC Salinas, CA, ranked 3205 | $0 |
|
| 3 | KATHERINE HEALTHCARE LLC Salinas, CA, ranked 3379 | $0 |
|
| 3 | SALINAS COMMUNITY HEALTHCARE, LLC Salinas, CA, ranked 3401 | $0 |
|
| 3 | SALINASIDENCE OPCO, LLC Salinas, CA, ranked 4402 | $0 |
|
| 3 | 200 LIGHTHOUSE, LLC Pacific Grove, CA, ranked 5583 | $0 |
|
| 3 | SHOMIR BANERJEE Salinas, CA, ranked 5658 | $0 |
|
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.