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Medicaid spending in Puerto Rico
9,168 providers based in Puerto Rico were paid $3.23B in outpatient and professional Medicaid claims from 2018 through 2024. The largest single code is 99213, doctor's office visit, returning patient (routine), at $136.36M. San Juan is the biggest billing hub.
28Total paid$3.23B
33Billing providers9,168
24GClaims146,432,316
On OIG exclusion list8
Box 33 · Billing provider
Who sent the bill in Puerto Rico
Cents of every dollar billed by Puerto Rico-based providers, grouped by each provider's primary NPPES type. Compare: nationally, agencies take 33¢ and physicians 11¢.
Box 32 · Location
By city
San Juan$730MGuaynabo$323MPonce$268MCaguas$218MBayamon$173MArecibo$123MManati$120MMayaguez$103MCarolina$99MHumacao$46MCayey$43MAibonito$42MBarceloneta$40MAguadilla$35MGuayama$35MSan German$33MVega Baja$33MToa Baja$32MSan Sebastian$30MGurabo$24MJuncos$22MHatillo$21MCorozal$21MVega Alta$20MRio Piedras$20MNaranjito$20MYauco$19MMoca$19MFajardo$18MRio Grande$18MJuana Diaz$18MSanta Isabel$18MCanovanas$17MCidra$17MToa Alta$16MTrujillo Alto$15MCoto Laurel$15MSan Lorenzo$14MLas Piedras$14MDorado$14MLares$13MBarranquitas$13MPatillas$13MIsabela$13MVillalba$12MAguada$12MYabucoa$12MSanturce$12MOrocovis$12MNaguabo$11M
Auditor's notes
Billing flags in Puerto Rico
Statistical outliers on claims per beneficiary, single-code billing, and OIG exclusion. Not evidence of fraud — how these work.
| # | Provider | Flags | Paid |
|---|---|---|---|
| 1 | Orthobone, INC | single-code billing | $15.46M |
| 2 | Eliel Ortho Medical Corp | single-code billing | $10.37M |
| 3 | Tech Medical Group, INC. | single-code billing | $7.84M |
| 4 | Ortho & Surgical Solutions, INC | single-code billing | $7.75M |
| 5 | Surgical Solutions-J.A. Puerto Rico, INC | single-code billing | $7.09M |
| 6 | Hospicio LA Paz INC | single-code billing | $5.71M |
| 7 | ST Lukes Episcopal Church Home Care Program | single-code billing | $2.91M |
| 8 | Bone Fix Innovation INC | single-code billing | $2.70M |
| 9 | Surgical Innovations Corp | single-code billing | $2.17M |
| 10 | Bard Shannon Limited | single-code billing | $1.21M |
| 11 | Nuvasive PR, INC. | single-code billing | $1.20M |
| 12 | Lopez, Ivette | single-code billing | $1.02M |
| 13 | Laboratorio Clinico San Juan INC | OIG excluded | $317K |
| 14 | Mathews Bermudez, Melvin | OIG excluded | $216K |
| 15 | Villanueva Valdes, Esther | OIG excluded | $27K |
| 16 | De Jesus, Jorge | OIG excluded | $23K |
| 17 | Muniz Molinero, Carlos | OIG excluded | $20K |
| 18 | Gallardo, Diana | OIG excluded | $19K |
| 19 | Rodriguez Cespedes, Nelsa | OIG excluded | $0.00 |
| 20 | Cubano, Cesar | OIG excluded | $0.00 |
Ranked
Top 100 providers in Puerto Rico
| # | Provider | Type | City | Claims | Paid |
|---|---|---|---|---|---|
| 1 | Alivia Specialty, LLC | Supplier | Guaynabo | 105,104 | $188.98M |
| 2 | Farmacia Doral, INC. | Supplier | San Juan | 82,396 | $115.61M |
| 3 | Laboratorio De Patologia DR Noy | Physician | San Juan | 1,300,653 | $45.63M |
| 4 | Hato Rey Pathology Associates INC | Lab | San Juan | 705,568 | $42.02M |
| 5 | Best Option Healthcare Puerto Rico LLC | Supplier | San Juan | 278,810 | $41.49M |
| 6 | Laboratorio Clinico Borinquen, INC | Lab | Caguas | 2,792,951 | $37.05M |
| 7 | Learn & Grow Therapy Group LLC | Behavioral | Barceloneta | 530,386 | $32.18M |
| 8 | Pediatric Home Care Services LLC | Nursing facility | San Juan | 42,360 | $31.76M |
| 9 | Elderly Transportation Services, LLC | Transport | Guaynabo | 631,690 | $25.56M |
| 10 | Nazareno Enterprises and Services LLC | Supplier | Bayamon | 35,771 | $23.76M |
| 11 | Absolife FMS Corp | Supplier | San Juan | 75,017 | $23.47M |
| 12 | Home Orthopedics Corp | Supplier | San Juan | 8,736 | $20.67M |
| 13 | Medtronic Puerto Rico Operations | Supplier | Guaynabo | 134,288 | $19.74M |
| 14 | Caribbean Imaging and Radiation Treatment Center,inc | Clinic | Ponce | 181,880 | $19.33M |
| 15 | Southern Pathology Services, INC. | Physician | Ponce | 348,318 | $18.95M |
| 16 | Northwest Pathology CSP | Lab | Manati | 91,885 | $16.91M |
| 17 | Vimar Therapy Group INC | Clinic | Carolina | 401,634 | $16.70M |
| 18 | Orthobone, INC | Supplier | San Juan | 3,797 | $15.46M |
| 19 | Quest Diagnostics of Puerto Rico INC | Lab | San Juan | 791,341 | $14.87M |
| 20 | Sociedad De Servicios Neonatales De Arecibo | Physician | Arecibo | 48,181 | $14.33M |
| 21 | Coreplus Servicios Clinicos Y Patologicos LLC | Lab | Carolina | 405,943 | $13.04M |
| 22 | Special Care Pharmacy Services, LLC | Supplier | San Juan | 15,519 | $12.90M |
| 23 | MSL Therapeutical Services, PSC | Caguas | 186,263 | $12.79M | |
| 24 | Smith & Nephew INC. | Supplier | San Juan | 6,130 | $12.00M |
| 25 | Laboratorio Clinico Toledo, LLC | Lab | Arecibo | 665,679 | $11.87M |
| 26 | Laboratorio Clinico Bairoa INC | Lab | Caguas | 816,830 | $11.28M |
| 27 | Alivia Infusion Services LLC | Supplier | Ponce | 15,169 | $10.93M |
| 28 | Centro Medico Del Turabo INC | Clinic | Caguas | 388,236 | $10.83M |
| 29 | Compression Health Care INC | Supplier | Ponce | 183,016 | $10.63M |
| 30 | Eliel Ortho Medical Corp | Supplier | San Juan | 4,855 | $10.37M |
| 31 | Laboratorio Clinico Noy , INC. | Lab | San Juan | 382,356 | $9.89M |
| 32 | Jose Carlos Flores Santiago | Lab | Juncos | 736,738 | $9.64M |
| 33 | Pci Group LLC | Physician | Manati | 90,085 | $9.54M |
| 34 | Cuerpo De Emergencias Medicas De | Transport | Guaynabo | 88,222 | $9.41M |
| 35 | Vita Healthcare INC | Physician | San Juan | 62,446 | $9.37M |
| 36 | Lubilu Therapy Group, LLC | Ponce | 235,996 | $9.28M | |
| 37 | Axiscare Health Logistics INC | Supplier | Toa Baja | 332,824 | $9.12M |
| 38 | Mennonite General Hospital INC | Aibonito | 249,598 | $8.35M | |
| 39 | Puerto Rico Medical Emergency Group P.S.C. | Physician | Ponce | 200,167 | $8.17M |
| 40 | Tech Medical Group, INC. | Supplier | San Juan | 808 | $7.84M |
| 41 | Ortho & Surgical Solutions, INC | Supplier | Guaynabo | 3,313 | $7.75M |
| 42 | RMC Orthopedic & Surgical, INC. | Supplier | Guaynabo | 4,534 | $7.53M |
| 43 | Laboratorio Clinico Y Bacteriologico Genesis INC. | Lab | Patillas | 641,611 | $7.51M |
| 44 | Advance Therapy Group PSC | Gurabo | 167,014 | $7.42M | |
| 45 | Precision Hearing Center INC | San Juan | 183,807 | $7.36M | |
| 46 | Surgical Solutions-J.A. Puerto Rico, INC | Supplier | Guaynabo | 3,134 | $7.09M |
| 47 | Mayaguez Medical Center DR Ramon Emeterio Betances INC | Clinic | Mayaguez | 163,175 | $7.05M |
| 48 | Recinto De Ciencias Medicas | Physician | Carolina | 177,997 | $6.83M |
| 49 | Mediko Imaging INC. | Clinic | Caguas | 115,529 | $6.82M |
| 50 | Puerto Rico Pathology Associates P | Physician | San Juan | 90,005 | $6.78M |
| 51 | Consolidated Radiology Complex CSP | Clinic | Caguas | 76,070 | $6.75M |
| 52 | Ammvr Group, INC | Lab | Hato Rey | 366,511 | $6.72M |
| 53 | Metro Pavia at Home, LLC | Agency | Arecibo | 67,780 | $6.59M |
| 54 | Caribbean Cancer Care Services, LLC | Physician | Ponce | 138,660 | $6.48M |
| 55 | DR Jose a Nassar & Asociados | Physician | Humacao | 189,430 | $6.27M |
| 56 | Centro De Hematologia Y Oncologia Del Sur, CSP | Clinic | Santa Isabel | 70,471 | $6.24M |
| 57 | CT Radiology Complex, LLC | Physician | Bayamon | 79,886 | $6.19M |
| 58 | Sports and Pain Interventions PSC | Clinic | Hormigueros | 316,128 | $6.05M |
| 59 | Grupo Neonatal C.S.P. | Physician | San Juan | 15,197 | $6.02M |
| 60 | Aps Clinics of Puerto Rico, INC. | Clinic | San Juan | 1,398,809 | $5.77M |
| 61 | Southern Pathology Services, INC. | Lab | Ponce | 164,397 | $5.72M |
| 62 | Centro Cardiovascular De Manati III CSP | Physician | Manati | 73,810 | $5.72M |
| 63 | Hospicio LA Paz INC | Agency | Arecibo | 3,132 | $5.71M |
| 64 | Caribbean Heart Institute LLC | Physician | Caguas | 61,264 | $5.69M |
| 65 | Metro Pavia at Home LLC | Agency | San Juan | 58,656 | $5.58M |
| 66 | Nuscan CSP | Physician | Caguas | 30,085 | $5.54M |
| 67 | Axiscare Health Logistics INC | Supplier | Toa Baja | 15,547 | $5.49M |
| 68 | Grupo Intensivo Pediatrico De San Juan | Physician | San Juan | 15,062 | $5.48M |
| 69 | Conmed Laboratories INC | Lab | Caguas | 408,383 | $5.42M |
| 70 | Recinto De Ciencias Medicas | Physician | San Juan | 30,334 | $5.42M |
| 71 | Tiber Health, Public Benefit Corporation | Behavioral | Ponce | 124,535 | $5.12M |
| 72 | Anestesia Del Norte P.S.C. | Manati | 59,812 | $4.98M | |
| 73 | Oficina Medica DR Quintero PSC | Ponce | 50,766 | $4.94M | |
| 74 | Metro Mayaguez INC | Hospital | Mayaguez | 90,232 | $4.92M |
| 75 | Mogic Ob-Gyn PSC | Physician | Manati | 99,071 | $4.86M |
| 76 | Migrant Health Center Western Region,inc | Lab | Mayaguez | 417,795 | $4.81M |
| 77 | Pet Diagnostic Imaging Corp | Clinic | Ponce | 6,001 | $4.77M |
| 78 | Centro De Diagnostico Y Tratamiento De Rio Grande | Clinic | Rio Grande | 78,968 | $4.73M |
| 79 | CDT GMSP, INC | Lab | Bayamon | 320,668 | $4.66M |
| 80 | Raul Medina | Transport | Rio Grande | 52,270 | $4.62M |
| 81 | Centro Cardiovascular De San German,csp | Physician | San German | 33,016 | $4.57M |
| 82 | Municipality of San Juan | Hospital | San Juan | 136,169 | $4.53M |
| 83 | Retina Care PSC | Physician | Arecibo | 109,765 | $4.32M |
| 84 | Recinto De Ciencias Medicas | Physician | San Juan | 121,863 | $4.21M |
| 85 | Centro Oftalmologico Metropolitano CSP | Physician | San Juan | 100,581 | $4.20M |
| 86 | SPS Specialty Pharmacy Services INC | Supplier | Caguas | 7,541 | $4.18M |
| 87 | Gracia-Lopez, Sandra | Physician | Aibonito | 11,122 | $4.05M |
| 88 | Silva Caraballo, David | Physician | San German | 70,366 | $4.05M |
| 89 | Velez Cortes, Hector | Physician | Ponce | 73,199 | $3.95M |
| 90 | Recinto De Ciencias Medicas | Physician | San Juan | 67,300 | $3.95M |
| 91 | Alameda Prosthodontic Services, PSC | Dental | Mayaguez | 159,510 | $3.95M |
| 92 | Diaz - Rodriguez, Ruben | Physician | Bayamon | 35,284 | $3.94M |
| 93 | Centro Medico Del Turabo, INC. | Agency | Bayamon | 93,088 | $3.88M |
| 94 | MPL Maxillofacial Surgery, PSC | Dental | San Sebastian | 53,146 | $3.84M |
| 95 | Diaz-Abascal, Jose | Dental | Caguas | 49,343 | $3.83M |
| 96 | Hospital De LA Concepcion INC | Hospital | San German | 96,955 | $3.82M |
| 97 | Arecibo Pathology Services CSP | Physician | Aibonito | 45,438 | $3.81M |
| 98 | Integral Therapy Center | Clinic | Arecibo | 110,720 | $3.81M |
| 99 | Pediatrix Medical Group, S.P. | Physician | Guaynabo | 64,510 | $3.78M |
| 100 | Recinto De Ciencias Medicas | Physician | Rio Piedras | 82,792 | $3.77M |