Providers
All 20 in NY
NELSON RAFAEL GIRALDO, M.D.
NPI 1902996093, individual, Bay Shore, NY, Family Medicine
1
Evidence tier
documented action, then payment
- Listed on the Medicare revocation list since September 13, 2021.
- Medicaid still paid claims in 11 later months, $8,071 in total.
score 94 of 100, rank 301, $8K at stake
Public list actions
Medicare revocation effective September 13, 2021, barred from re-enrolling until September 13, 2031
424.535(a)(9) failure to report and 424.535(a)(3) felonies, Practitioner - Family Practice, NY
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 |
|---|---|---|---|---|---|---|---|---|
| Medicare revocation list 424.535(a)(9) failure to report and 424.535(a)(3) felonies | Exact NPI, name verified | Sep 13, 2021 | Sep 13, 2031 | 11 | Oct 2021 | Oct 2022 | $8K | $6K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | NELSON RAFAEL GIRALDO, M.D. |
| Type | Individual, sole proprietor |
| Status | Active |
| NPI issued | October 13, 2006, last updated May 23, 2019 |
| Practice location | 10 BRENTWOOD RD, Bay Shore, NY 11706, 631-665-8007 |
| Specialties | Family Medicine (207Q00000X, primary, license 175993 NY) |
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 | |
|---|---|---|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | $23K | 89% | $25 | $44 (top 5% from $110) | 21st percentile | |
| G0463 | Medicaid service code | $2K | 9% | $67 | $73 (top 5% from $142) | too few months to rank | |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $499 | 2% | $42 | $60 (top 5% from $133) | too few months to rank | |
| 99441 | Telephone medical discussion with physician, 5-10 minutes | $25 | 0% | $1.96 | $11 (top 5% from $106) | too few months to rank |
In this area
20 providers in Suffolk County, NY carry an indicator in the public record, with $21.2M at stake between them. The most common is more hours than a day holds, on 13 of them, followed by paid after a public list action on 3. 5 are tier 1: documented action, then payment.
| tier | provider | at stake | why |
|---|---|---|---|
| 1 | NEW WAVE DIAGNOSTIC RADIOLOGY PLLC Oakdale, NY, ranked 5 | $580K |
|
| 1 | HASIB SARIJ Farmingdale, NY, ranked 15 | $119K |
|
| 1 | ISLAND PAIN SPECIALIST, PC Farmingdale, NY, ranked 141 | $119K |
|
| 1 | VISHNUDAT SEODAT Riverhead, NY, ranked 200 | $44K |
|
| 1 | KENNETH FISHBERGER Port Jefferson, NY, ranked 517 | $0 |
|
| 3 | OAKWOOD OPERATING CO, LLC Oakdale, NY, ranked 3394 | $0 |
|
| 3 | SUNRISE MANOR NURSING HOME, INC. Bay Shore, NY, ranked 4370 | $0 |
|
| 4 | JANINE STIENE Stony Brook, NY, ranked 7784 | $1.3M |
|
Recent enforcement in NY
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
DOJIndictedAug 20, 2026
Four Members Of The “War Room” Charged In Connection With $12 Million Medicaid Fraud Scheme
Members of a Bronx-based racketeering organization known as the "War Room" fabricated ride data for methadone clinic transportation using a GPS spoofing application, paid Medicaid patients kickbacks in cash and drugs for their enrollment information, provided the fake data to transportation companies that submitted over $12 million in claims to Medicaid, and laundered the proceeds.
DOJIndictedAug 20, 2026
Four Members of the “War Room” Charged in Connection with $12M Medicaid Fraud Scheme
Four members of a Bronx racketeering organization known as the "War Room" fabricated medical transportation ride data using a ride-tracking app and GPS spoofing, paid Medicaid patients at methadone clinics kickbacks in cash and drugs for their enrollment information, provided the fake data to transportation companies that submitted over $12 million in Medicaid claims, and laundered the proceeds.
DOJCivil settlementAug 17, 2026
Safire nursing homes agree to pay $9 million to resolve fraudulent Medicare and Medicaid billing allegations
The United States alleged that Safire submitted false claims to Medicare and Medicaid for skilled rehabilitative therapy services that were not reasonable or necessary, not supported by medical records, not documented as provided, or not provided at all, including by scheduling therapy based on insurer reimbursement policies, pressuring therapists and residents, and manufacturing or altering therapy referrals and medical records.
DOJSentencedJul 21, 2026
Owner of Long Island Ambulette Services Company Sentenced to Prison for Multimillion Dollar Healthcare Fraud Scheme
Arshad and co-conspirators paid kickbacks to Medicaid beneficiaries to order transportation through his companies and billed Medicaid over $19 million for medical transportation rides that were not provided, including for individuals who were deceased, hospitalized or incarcerated, and inflated reimbursements with false pickup addresses and distant treatment centers.
DOJIndictedJul 2, 2026
Two Defendants Charged with Multi-Million Dollar Health Care Fraud Scheme
The defendants, who owned and operated Tri-Hamlet Taxi Inc., allegedly paid kickbacks to Medicaid beneficiaries and submitted more than $35 million in claims to Medicaid for ambulette trips that were not provided or whose costs were inflated by using false pickup or drop-off addresses.
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.