MATIAS CLINICAL LABORATORY INC

This referral candidate is a clinical laboratory organization in Baldwin Park, California that bills Medicaid with Missouri listed as its home state. Records show it was revoked from Medicare on August 31, 2018 on three grounds, including false or misleading information and felonies, with a bar on re-enrolling until November 22, 2034, and it also appears on the California Medi-Cal Suspended and Ineligible Provider List with the same date. Medicaid records show payments continued after that date, totaling $3,846,471 over 44 service months from September 2018 through April 2022, compared with $312,286 in the twelve months before. Its largest paid code is the high throughput COVID-19 test U0003 at $729,801 over 24 months, priced at $120 per patient-month against a typical $75, which is the 88th percentile among providers billing that code. A second nucleic acid detection code, 87798, accounts for $672,654 over 49 months at $64 per patient-month against a typical $33.

1. 01NPI 1962546176 is registered to MATIAS CLINICAL LABORATORY INC, an organization in Baldwin Park, CA, with taxonomy 291U00000X and a Medicaid home state of MO. records 1
2. 02The provider was revoked on 2018-08-31 under 424.535(A)(4) False Or Misleading Information, 424.535(A)(3) Felonies and 424.535(A)(2) Provider Or Supplier Conduct (Exclusion), with a re-enrollment bar to 2034-11-22. records 9
3. 03After the Medicare revocation action of 2018-08-31, Medicaid paid $3,846,471 across 44 service months from 2018-09 to 2022-04, compared with $312,286 in the 12 months before. records 10
4. 04After the California state exclusion action of 2018-08-31, tied to the California Medi-Cal Suspended and Ineligible Provider List, Medicaid paid $3,846,471 across 44 service months from 2018-09 to 2022-04. records 11
5. 05The record is classified as evidence tier 1, documented action then payment, with detector D3 and dollars at risk of $3,846,471, described as the figure of the detector that set the tier and not a sum. records 8
6. 06Code U0003, the high throughput SARS-CoV-2 nucleic acid detection test, was paid $729,801 over 24 months, 18 percent of this provider's Medicaid dollars, at $120 per patient-month, ranking at the 88th percentile of all providers billing this code against a typical $75. records 2
7. 07Code 87798, detection test by nucleic acid for organism, amplified probe technique, was paid $672,654 over 49 months, 17 percent of this provider's Medicaid dollars, at $64 per patient-month, ranking at the 75th percentile against a typical $33. records 3
8. 08Code 87502, detection test by nucleic acid for multiple types influenza virus, was paid $348,859 over 49 months, 9 percent of this provider's Medicaid dollars, at $55 per patient-month, ranking at the 31st percentile against a typical $71. records 4
9. 09Code 87631, respiratory virus panel with 3 to 5 targets, was paid $279,418 over 31 months, 7 percent of this provider's Medicaid dollars, at $52 per patient-month, ranking at the 33rd percentile against a typical $74. records 5
10. 10Code 87634, respiratory syncytial virus nucleic acid detection, was paid $258,473 over 48 months, 7 percent of this provider's Medicaid dollars, at $41 per patient-month, ranking at the 39th percentile against a typical $48. records 6
11. 11Code G0483, definitive drug testing, was paid $206,715 over 25 months, 5 percent of this provider's Medicaid dollars, at $118 per patient-month, ranking at the 38th percentile against a typical $146. records 7

Request the full Medicaid enrollment file for NPI 1962546176, including the application, all revalidation and screening records, and any documentation of appeal, reinstatement or reversal of the Medicare revocation dated 2018-08-31 and of the California Medi-Cal Suspended and Ineligible listing. Confirm whether the provider appears in the termination database and whether denial or termination of enrollment was required under 42 CFR 455.416(c), and pull the monthly exclusion and NPPES screening logs required by 42 CFR 455.436 for the period September 2018 through April 2022 to establish when the state first matched this provider. Obtain the claim level detail behind the $3,846,471 paid across the 44 service months, with attention to the U0003 and 87798 lines and to whether claims were billed directly or through another billing entity, ordering provider or managed care plan. If the review supports a credible allegation of fraud, evaluate a full or partial payment suspension under 42 CFR 455.23(a) and make the referral to the Medicaid Fraud Control Unit required by 42 CFR 455.23(d), and document the specific 42 CFR 424.535(a) grounds cited in the Medicare action.

• The Medicare revocation may have been appealed, stayed or reversed, or the provider may have been reinstated, and the extract may not reflect the current status.
• Payments after the action date can reflect claims for dates of service before the action, timely filing lags, adjustments, voids or recoupments already applied, so the paid amount may not equal net dollars retained.
• The dollars at risk figure of $3,846,471 is described as the figure of the detector that set the tier and not a sum, so it should not be treated as a computed overpayment.
• T-MSIS and exclusion list data carry reporting lag, and the California list citation references a July 2026 file, so effective dates and match logic must be verified against source records before conclusions are drawn.
• The provider is a laboratory organization whose claims may be submitted under supervisory or referring provider billing conventions or through a managed care plan, so the entity receiving payment and the entity performing the service should be confirmed.
• Higher per patient-month amounts for U0003 and 87798 can reflect legitimate test mix, panel composition, specimen volume during the COVID-19 period or state fee schedule differences rather than any billing irregularity.
• Several codes, including 87502, 87631, 87634 and G0483, price below the typical amount and at low percentiles, which is not consistent with a uniform upcoding pattern.
• Name and address similarity is not identity; confirm that the Baldwin Park, California entity paid by Missouri Medicaid is the same entity named on the revocation and state exclusion lists.