ELLEN E PIERNOT, MD

NPI 1962583617, individual, Merced, CA, Family Medicine

Evidence tier

structure or single-organization volume

Hours beyond a day in 46 months, but with up to 9907 patients a month across 17 billing organizations, which points to a supervising clinician on the claims rather than one person's hours.
Records needed.

score 51 of 100, rank 8971, $1.0M 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
Jan 2018	More hours than a day holds, even counting one unit per claim line	90.4	10.7	7.1	9.6	6153	17	96151 97803 99202 99203 99211 99212 99213 99214 99215 99401	$20K
Feb 2018	More hours than a day holds, even counting one unit per claim line	78.9	8.2	5.4	7.6	4962	17	96150 97802 97803 99202 99203 99211 99212 99213 99214 99401	$14K
Mar 2018	More hours than a day holds, even counting one unit per claim line	72.5	8.0	5.3	7.5	5006	16	96151 97802 99202 99203 99211 99212 99213 99214 99401	$15K
Apr 2018	More hours than a day holds, even counting one unit per claim line	57.0	5.6	3.8	5.4	3858	17	99203 99204 99211 99212 99213 99214 99401	$10K
May 2018	More hours than a day holds, even counting one unit per claim line	54.9	6.1	4.1	5.5	3761	16	99202 99203 99204 99211 99212 99213 99214	$11K
Jun 2018	More hours than a day holds, even counting one unit per claim line	40.8	4.7	3.1	4.4	2884	14	99202 99211 99212 99213 99214	$8K
Jul 2018	More hours than a day holds, even counting one unit per claim line	37.2	4.9	3.3	4.6	2713	16	99203 99211 99212 99213 99214 G0442	$9K
Aug 2018	More hours than a day holds, even counting one unit per claim line	40.0	6.3	4.2	5.7	2962	14	99203 99211 99212 99213 99214 99401 G0442	$11K
Jan 2019	More hours than a day holds, even counting one unit per claim line	34.3	3.1	2.0	2.7	2553	4	97803 99202 99203 99211 99212 99213 99214 99401 G0442	$5K
Feb 2019	More hours than a day holds, even counting one unit per claim line	38.4	4.6	3.1	4.3	2660	6	97802 99202 99203 99211 99212 99213 99214 99401 G0442	$6K
Mar 2019	More hours than a day holds, even counting one unit per claim line	65.0	8.8	5.8	8.6	4751	6	96151 97803 99202 99203 99211 99212 99213 99214 99401 G0442	$14K
Apr 2019	More hours than a day holds, even counting one unit per claim line	76.1	10.5	7.0	9.5	5366	7	99202 99203 99211 99212 99213 99214 99401 G0442	$16K
May 2019	More hours than a day holds, even counting one unit per claim line	69.0	10.6	7.1	9.5	5118	6	96150 97802 97803 99202 99203 99211 99212 99213 99214 99401 G0442	$16K
Jun 2019	More hours than a day holds, even counting one unit per claim line	60.2	8.4	5.6	8.4	4388	7	99202 99203 99205 99211 99212 99213 99214 99401 G0442	$14K
Jul 2019	More hours than a day holds, even counting one unit per claim line	51.9	5.4	3.6	4.9	3856	2	99202 99203 99211 99212 99213 99214 99215 99401	$9K
Aug 2019	More hours than a day holds, even counting one unit per claim line	61.3	5.3	3.5	5.0	4605	3	96150 99202 99203 99211 99212 99213 99214 99401	$9K
Sep 2019	More hours than a day holds, even counting one unit per claim line	64.8	7.3	4.9	7.0	4672	3	96151 97802 97803 99202 99203 99211 99212 99213 99214 99215 99401 99402 99403	$12K
Oct 2019	More hours than a day holds, even counting one unit per claim line	70.8	6.5	4.4	5.9	5216	5	96150 96151 97802 99202 99203 99211 99212 99213 99214 99401 99402	$11K
Nov 2019	More hours than a day holds, even counting one unit per claim line	74.0	8.2	5.4	7.8	5198	6	96150 96151 97802 97803 99202 99203 99211 99212 99213 99214 99215 99401 99402 99403	$15K
Dec 2019	More hours than a day holds, even counting one unit per claim line	77.9	9.2	6.1	8.6	5581	7	96150 96151 97802 97803 99201 99202 99203 99211 99212 99213 99214 99215 99401 99402 99403	$18K
Jan 2020	More hours than a day holds, even counting one unit per claim line	88.9	12.4	8.2	11.1	6434	5	97802 97803 99201 99202 99203 99211 99212 99213 99214 99215 99401 99402 99403	$18K
Feb 2020	More hours than a day holds, even counting one unit per claim line	84.4	12.8	8.5	12.4	5741	6	97802 97803 99201 99202 99203 99211 99212 99213 99214 99215 99401 99402 99403	$18K
Mar 2020	More hours than a day holds, even counting one unit per claim line	75.5	12.5	8.3	11.7	6204	5	97802 97803 99202 99203 99211 99212 99213 99214 99215 99401 99402 99403	$15K
Apr 2020	More hours than a day holds, even counting one unit per claim line	66.8	15.8	10.5	14.4	6658	4	96158 97802 97803 99201 99202 99203 99211 99212 99213 99214 99401	$16K
May 2020	More hours than a day holds, even counting one unit per claim line	72.6	15.2	10.1	14.9	7236	6	97802 97803 99201 99202 99203 99205 99211 99212 99213 99214 99401	$18K
Jun 2020	More hours than a day holds, even counting one unit per claim line	78.4	14.9	9.9	13.5	7475	8	97802 97803 99201 99202 99203 99211 99212 99213 99214 99401	$18K
Jul 2020	More hours than a day holds, even counting one unit per claim line	74.5	18.6	12.4	16.7	7765	3	97802 97803 99201 99202 99203 99211 99212 99213 99214 99401	$28K
Aug 2020	More hours than a day holds, even counting one unit per claim line	79.4	17.1	11.4	16.8	7661	5	97802 97803 99201 99202 99203 99211 99212 99213 99214 99401	$22K
Sep 2020	More hours than a day holds, even counting one unit per claim line	81.2	14.0	9.3	12.7	7784	6	97802 97803 99201 99202 99203 99211 99212 99213 99214 99401	$18K
Oct 2020	More hours than a day holds, even counting one unit per claim line	72.8	14.5	9.7	13.7	6759	3	97802 97803 99201 99202 99203 99211 99212 99213 99214 99401	$20K
Nov 2020	More hours than a day holds, even counting one unit per claim line	69.2	13.7	9.1	13.0	6328	5	97802 97803 99201 99202 99203 99211 99212 99213 99214 99401	$17K
Dec 2020	More hours than a day holds, even counting one unit per claim line	72.2	14.0	9.3	12.5	7185	5	97802 97803 99201 99202 99203 99211 99212 99213 99214 99401	$18K
Jan 2021	More hours than a day holds, even counting one unit per claim line	67.1	12.6	8.4	12.4	6167	4	97802 97803 99202 99203 99204 99205 99211 99212 99213 99214 99215 99401	$20K
Feb 2021	More hours than a day holds, even counting one unit per claim line	69.3	17.5	11.7	16.4	5657	4	97802 97803 99202 99203 99204 99211 99212 99213 99214 99215 99401	$23K
Mar 2021	More hours than a day holds, even counting one unit per claim line	68.8	27.4	18.3	24.6	6077	6	97802 97803 99202 99203 99204 99205 99211 99212 99213 99214 99215 99401 99402	$40K
Apr 2021	More hours than a day holds, even counting one unit per claim line	94.8	25.0	16.7	22.7	6812	5	99202 99203 99204 99205 99211 99212 99213 99214 99215	$40K
May 2021	More hours than a day holds, even counting one unit per claim line	82.8	22.4	14.9	22.1	6258	3	99202 99203 99204 99205 99211 99212 99213 99214 99215 99401	$35K
Jun 2021	More hours than a day holds, even counting one unit per claim line	93.4	27.5	18.3	25.0	7892	5	97802 99202 99203 99204 99205 99211 99212 99213 99214 99215 99402	$36K
Jul 2021	More hours than a day holds, even counting one unit per claim line	91.0	24.9	16.6	23.4	7986	6	97802 97803 99202 99203 99204 99205 99211 99212 99213 99214	$35K
Aug 2021	More hours than a day holds, even counting one unit per claim line	106.2	34.9	23.3	32.8	9658	5	97802 97803 99202 99203 99204 99205 99211 99212 99213 99214 99215 99401	$50K
Sep 2021	More hours than a day holds, even counting one unit per claim line	109.2	38.0	25.3	34.5	9907	7	97802 97803 99202 99203 99204 99205 99211 99212 99213 99214 99215	$50K
Oct 2021	More hours than a day holds, even counting one unit per claim line	79.7	34.9	23.3	34.3	7482	4	97802 97803 99202 99203 99204 99205 99211 99212 99213 99214 99401	$44K
Nov 2021	More hours than a day holds, even counting one unit per claim line	77.2	32.1	21.4	29.2	6820	4	97802 97803 99202 99203 99204 99205 99211 99212 99213 99214 99215 99401	$41K
Dec 2021	More hours than a day holds, even counting one unit per claim line	72.9	28.5	19.0	25.6	6600	5	97802 99202 99203 99204 99205 99211 99212 99213 99214 99215 99401	$43K
Jan 2022	More hours than a day holds, even counting one unit per claim line	98.5	39.4	26.3	38.8	9212	6	97802 97803 99202 99203 99204 99205 99211 99212 99213 99214 99401	$57K
Feb 2022	More hours than a day holds, even counting one unit per claim line	96.3	36.5	24.3	34.0	7704	7	97802 97803 99202 99203 99204 99205 99211 99212 99213 99214 99215	$50K

National provider registry

From the CMS NPPES Registry, refreshed daily.

Name	ELLEN E PIERNOT, MD
Type	Individual
Status	Active
NPI issued	October 18, 2006, last updated May 11, 2021
Practice location	737 W CHILDS AVE, Merced, CA 95341-6805, 209-385-5481
Mailing address	2927 MONTANA AVE, Merced, CA 95340-2516
Specialties	Family Medicine (207Q00000X, license 48550 AZ) Family Medicine (207Q00000X, license MD20070158 NM) Family Medicine (207Q00000X, license 48578-020 WI) Family Medicine (207Q00000X, primary, license C135085 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	$62.7M	93%	$166	$182 (top 5% from $488)	43rd percentile
99213	Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more	$413K	1%	$1.70	$44 (top 5% from $110)	6th percentile
59425	Medicaid service code	$381K	1%	$76	$90 (top 5% from $160)	33rd percentile
99394	Medicaid service code	$285K	0%	$64	$83 (top 5% from $128)	34th percentile
99393	Medicaid service code	$267K	0%	$54	$78 (top 5% from $121)	27th percentile
99214	Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	$253K	0%	$2.17	$60 (top 5% from $133)	4th percentile
90471	Administration of vaccine	$241K	0%	$7.34	$10 (top 5% from $23)	39th percentile
90651	Medicaid service code	$205K	0%	$42	$1.93 (top 5% from $51)	93rd percentile

Medicare Part B 2024, largest codes

code	what it is	services	beneficiaries	paid	submitted per service	allowed per service	charge to allowed	usual for this code
99214	Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	24	20	$3K	$357	$137	2.6x	2.3x (90th percentile 3.8x)
99213	Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more	22	22	$2K	$243	$97	2.5x	2.2x (90th percentile 3.8x)

A submitted charge many times the allowed amount is common and lawful; it matters when it is far above what other providers submit for the same code.

In this area

23 providers in Merced County, CA carry an indicator in the public record, with $29.1M at stake between them. The most common is more hours than a day holds, on 20 of them, followed by part of a provider network on 2. 1 is tier 1: documented action, then payment.

tier	provider	at stake	why
1	RODOLFO GARCIA Los Banos, CA, ranked 425	$288	Listed on the CA Medicaid exclusion list since May 10, 2019. Medicaid still paid claims in 1 later month, $288 in total.
3	BRISTOL HOSPICE - CALIFORNIA, LLC Merced, CA, ranked 1211	$338K	Part of provider network D1-00104, ranked 104 nationally.
3	AVALON CARE CENTER-MERCED FRANCISCAN LLC Merced, CA, ranked 4649	$0	Part of provider network D1-00104, ranked 104 nationally.
4	MIRANDA FURIE Merced, CA, ranked 7284	$7.6M	Hours beyond a day in 30 months, but with up to 742 patients a month, which points to a supervising clinician on the claims rather than one person's hours. Records needed. and 2 more
4	PRIYANKA JAIN Merced, CA, ranked 7905	$634K	Hours beyond a day in 2 months, but with up to 506 patients a month, which points to a supervising clinician on the claims rather than one person's hours. Records needed. and 1 more
4	ABHILASHA SHARMA Merced, CA, ranked 7961	$423K	Hours beyond a day in 26 months, but with up to 4678 patients a month across 4 billing organizations, which points to a supervising clinician on the claims rather than one person's hours. Records needed. and 1 more
4	KARTHIKEYA DEVIREDDY Los Banos, CA, ranked 8509	$3.4M	Hours beyond a day in 80 months, but with up to 4201 patients a month across 4 billing organizations, which points to a supervising clinician on the claims rather than one person's hours. Records needed.
4	GEORGE ALKHOURI Merced, CA, ranked 8725	$2.0M	Hours beyond a day in 23 months, but with up to 1649 patients a month across 3 billing organizations, which points to a supervising clinician on the claims rather than one person's hours. Records needed.

All 23 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

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