Providers
CAROL ELIZABETH GRIFFIN, DO
NPI 1912269408, individual, Arcata, CA, Family Medicine
4
Evidence tier
structure or single-organization volume
- Hours beyond a day in 16 months, but with up to 763 patients a month across 7 billing organizations, which points to a supervising clinician on the claims rather than one person's hours.
- Records needed.
- Medicaid dollars per patient on code 99204 ($256 per patient-month) sit in the top 5% of every provider billing that code.
score 55 of 100, rank 7727, $1.7M 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 |
|---|---|---|---|---|---|---|---|---|---|
| Aug 2022 | More hours than a day holds at a conservative unit price | 9.3 | 50.0 | 33.3 | 44.9 | 763 | 7 | 99202 99203 99204 99211 99212 99213 99214 | $90K |
| Sep 2022 | More hours than a day holds at a conservative unit price | 7.7 | 39.7 | 26.5 | 36.1 | 607 | 7 | 99202 99203 99204 99211 99212 99213 99214 | $68K |
| Jan 2023 | More hours than a day holds at a conservative unit price | 7.4 | 40.6 | 27.1 | 38.2 | 607 | 6 | 99202 99203 99204 99211 99212 99213 99214 | $69K |
| Feb 2023 | More hours than a day holds at a conservative unit price | 8.3 | 43.9 | 29.3 | 41.0 | 578 | 4 | 99202 99203 99204 99211 99212 99213 99214 | $68K |
| Mar 2023 | More hours than a day holds at a conservative unit price | 7.5 | 42.2 | 28.1 | 37.9 | 601 | 5 | 99202 99203 99204 99211 99212 99213 99214 | $72K |
| May 2023 | More hours than a day holds at a conservative unit price | 6.3 | 37.9 | 25.2 | 34.0 | 543 | 5 | 99202 99203 99204 99211 99212 99213 99214 | $58K |
| Jun 2023 | More hours than a day holds at a conservative unit price | 6.5 | 37.1 | 24.7 | 33.7 | 503 | 4 | 99202 99203 99204 99212 99213 99214 | $60K |
| Jul 2023 | More hours than a day holds at a conservative unit price | 7.3 | 39.8 | 26.6 | 39.2 | 600 | 5 | 99202 99203 99204 99212 99213 99214 | $68K |
| Aug 2023 | More hours than a day holds at a conservative unit price | 8.0 | 41.4 | 27.6 | 37.2 | 632 | 5 | 99202 99203 99204 99211 99212 99213 99214 | $75K |
| Oct 2023 | More hours than a day holds at a conservative unit price | 6.5 | 41.1 | 27.4 | 38.6 | 524 | 5 | 99202 99203 99204 99212 99213 99214 | $67K |
| Feb 2024 | More hours than a day holds at a conservative unit price | 6.6 | 37.8 | 25.2 | 34.8 | 512 | 5 | 99202 99203 99204 99211 99212 99213 99214 | $59K |
| Apr 2024 | More hours than a day holds at a conservative unit price | 5.6 | 40.2 | 26.8 | 36.6 | 479 | 4 | 99202 99203 99204 99212 99213 99214 | $55K |
| May 2024 | More hours than a day holds at a conservative unit price | 6.0 | 41.3 | 27.5 | 37.1 | 535 | 4 | 99202 99203 99204 99211 99212 99213 99214 | $63K |
| Jul 2024 | More hours than a day holds at a conservative unit price | 4.9 | 37.0 | 24.6 | 33.2 | 431 | 4 | 99202 99203 99204 99212 99213 99214 | $53K |
| Aug 2024 | More hours than a day holds at a conservative unit price | 5.3 | 40.6 | 27.0 | 38.1 | 467 | 4 | 99202 99203 99204 99211 99212 99213 99214 | $57K |
| Oct 2024 | More hours than a day holds at a conservative unit price | 6.7 | 48.1 | 32.1 | 43.2 | 594 | 5 | 99202 99203 99204 99212 99213 99214 | $69K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | CAROL ELIZABETH GRIFFIN, DO |
| Type | Individual |
| Status | Active |
| NPI issued | June 12, 2012, last updated May 16, 2023 |
| Practice location | 1600 WEEOT WAY, Arcata, CA 95521-4734, 707-825-5000 |
| Specialties | Family Medicine (207Q00000X, license T1279 ME) Family Medicine (207Q00000X, license A-1905-15 NM) Family Medicine (207Q00000X, primary, license 20A16542 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 | |
|---|---|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $552K | 19% | $130 | $60 (top 5% from $133) | 95th percentile | |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | $450K | 16% | $91 | $44 (top 5% from $110) | 92nd percentile | |
| 99212 | Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more | $289K | 10% | $68 | $28 (top 5% from $147) | 87th percentile | |
| 99204 | New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more | $242K | 8% | $256 | $95 (top 5% from $171) | 99th percentile | |
| 87806 | Detection test by immunoassay with direct visual observation for hiv-1 antigen, with hiv-1 and hiv-2 antibodies | $222K | 8% | $24 | $25 (top 5% from $35) | 46th percentile | |
| J3490 | Unclassified drugs | $217K | 8% | $30 | $4.55 (top 5% from $108) | 82nd percentile | |
| T1015 | Medicaid service code | $194K | 7% | $287 | $182 (top 5% from $488) | 81st percentile | |
| 99203 | New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more | $179K | 6% | $222 | $67 (top 5% from $121) | 99th percentile |
In this area
4 providers in Humboldt County, CA carry an indicator in the public record, with $5.1M at stake between them. The most common is more hours than a day holds, on 4 of them.
| tier | provider | at stake | why |
|---|---|---|---|
| 4 | MARISSA KUMMERLING Eureka, CA, ranked 8670 | $2.3M |
|
| 4 | MALIA HONDA Eureka, CA, ranked 8732 | $2.0M |
|
| 5 | ELIZABETH MICKS Arcata, CA, ranked 10197 | $669K |
|
| 5 | ANTHONY PIROUZ Redway, CA, ranked 10415 | $157K |
|
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.