PAUL ANDREW STANTON, MD

NPI 1902888530, individual, Apple Valley, CA, Orthopaedic Surgery

Evidence tier

documented action, then payment

Listed on the CA Medicaid exclusion list since January 23, 2019.
Medicaid still paid claims in 1 later month, $2,462 in total.

score 93 of 100, rank 358, $2K 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	Jan 23, 2019	still open	1	Aug 2019	Aug 2019	$2K	$0

National provider registry

From the CMS NPPES Registry, refreshed daily.

Name	PAUL ANDREW STANTON, MD
Type	Individual
Status	Active
NPI issued	November 18, 2005, last updated July 20, 2007
Practice location	15990 TUSCOLA RD, Apple Valley, CA 92307-2111, 760-242-4808
Specialties	Orthopaedic Surgery (207X00000X, primary, license G85199 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
99204	New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	$2K	74%	$189	$95 (top 5% from $171)	too few months to rank
99213	Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more	$882	26%	$68	$44 (top 5% from $110)	too few months to rank

In this area

214 providers in San Bernardino County, CA carry an indicator in the public record, with $174.5M at stake between them. The most common is part of a provider network, on 111 of them, followed by more hours than a day holds on 98. 2 are tier 1: documented action, then payment.

tier	provider	at stake	why
1	MAGALY VELASQUEZ Rancho Cucamonga, CA, ranked 18	$60K	Listed on the Medicare revocation list and a state attorney general release since July 19, 2024. Medicaid still paid claims in 4 later months, $59,903 in total. and 2 more
1	MAGALY M VELASQUEZ DDS PROFESSIONAL DENTAL CORP Rancho Cucamonga, CA, ranked 174	$60K	Listed on the Medicare revocation list since July 19, 2024. Medicaid still paid claims in 4 later months, $59,903 in total.
3	CALSTRO HOSPICE INC. Montclair, CA, ranked 949	$2.8M	Part of provider network D1-00023, ranked 23 nationally.
3	FLOWER HOME HEALTH INC. Rancho Cucamonga, CA, ranked 1002	$1.5M	Part of provider network D1-00007, ranked 7 nationally.
3	SUNCREST HOME HEALTH SERVICES, INC. Chino, CA, ranked 1066	$866K	Part of provider network D1-00039, ranked 39 nationally.
3	ACES HOME HEALTHCARE SERVICES, INC Montclair, CA, ranked 1142	$518K	Part of provider network D1-00042, ranked 42 nationally.
3	VANURA HOMEHEALTH SERVICES, INC. Rancho Cucamonga, CA, ranked 1154	$482K	Part of provider network D1-00092, ranked 92 nationally.
3	NOVA HOME HEALTH INC. Upland, CA, ranked 1266	$230K	Part of provider network D1-00102, ranked 102 nationally.

All 214 in CA

Recent enforcement in CA

All releases

Department 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.

Ask this case

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