Providers
THRESA HELEN SIMON, M.D.
NPI 1003871989, individual, Petersburg, VA, Psychiatry & Neurology, Child & Adolescent Psychiatry
4
Evidence tier
structure or single-organization volume
- Hours beyond a day in 62 months, but with up to 629 patients a month, which points to a supervising clinician on the claims rather than one person's hours.
- Records needed.
- Medicaid dollars per patient on code 99309 ($506 per patient-month) sit in the top 5% of every provider billing that code.
score 56 of 100, rank 7491, $4.0M 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 2019 | More hours than a day holds at a conservative unit price | 14.2 | 38.8 | 25.9 | 34.9 | 377 | 1 | 99213 99214 99215 99222 99223 99231 99232 99233 99238 99309 | $41K |
| May 2019 | More hours than a day holds at a conservative unit price | 20.4 | 41.0 | 27.3 | 36.8 | 466 | 1 | 90833 99213 99214 99215 99222 99223 99231 99232 99233 99238 99309 | $46K |
| Jul 2019 | More hours than a day holds at a conservative unit price | 14.1 | 37.3 | 24.8 | 33.5 | 294 | 1 | 99205 99213 99214 99215 99223 99231 99232 99233 99238 99309 | $34K |
| Sep 2019 | More hours than a day holds at a conservative unit price | 14.0 | 39.6 | 26.4 | 37.7 | 308 | 1 | 90791 90792 99205 99213 99214 99215 99223 99231 99232 99233 99238 99309 | $37K |
| Oct 2019 | More hours than a day holds at a conservative unit price | 16.2 | 44.5 | 29.7 | 40.0 | 350 | 1 | 90791 90792 99205 99213 99214 99215 99222 99223 99231 99232 99233 99238 99309 | $43K |
| Dec 2019 | More hours than a day holds at a conservative unit price | 15.0 | 37.6 | 25.0 | 35.3 | 338 | 1 | 90792 99213 99215 99223 99231 99232 99233 99238 99309 | $39K |
| Feb 2020 | More hours than a day holds at a conservative unit price | 14.8 | 42.8 | 28.6 | 41.4 | 351 | 1 | 99205 99213 99214 99215 99222 99223 99231 99232 99233 99238 99309 | $41K |
| Mar 2020 | More hours than a day holds at a conservative unit price | 15.7 | 44.8 | 29.9 | 42.1 | 355 | 1 | 90792 99213 99214 99223 99231 99232 99233 99238 99309 | $46K |
| Apr 2020 | More hours than a day holds at a conservative unit price | 14.2 | 41.2 | 27.4 | 37.4 | 283 | 1 | 90792 90833 99213 99214 99223 99231 99232 99233 99238 99309 | $41K |
| May 2020 | More hours than a day holds at a conservative unit price | 12.8 | 37.6 | 25.1 | 37.0 | 253 | 1 | 90792 90833 99213 99214 99215 99223 99231 99232 99233 99238 99309 | $38K |
| Jun 2020 | More hours than a day holds at a conservative unit price | 14.4 | 43.8 | 29.2 | 39.8 | 279 | 1 | 90792 90833 99213 99214 99215 99223 99231 99232 99233 99238 99309 | $45K |
| Jul 2020 | More hours than a day holds at a conservative unit price | 15.9 | 43.6 | 29.1 | 39.2 | 425 | 1 | 90792 90833 99213 99214 99215 99223 99231 99232 99233 99238 99309 | $52K |
| Aug 2020 | More hours than a day holds at a conservative unit price | 15.5 | 43.9 | 29.3 | 43.3 | 419 | 1 | 90792 90833 99213 99214 99215 99222 99223 99231 99232 99233 99238 99309 99443 | $50K |
| Sep 2020 | More hours than a day holds at a conservative unit price | 16.1 | 44.9 | 30.0 | 40.8 | 419 | 1 | 90792 90833 99213 99214 99215 99223 99231 99232 99233 99238 99309 99443 | $52K |
| Oct 2020 | More hours than a day holds at a conservative unit price | 16.2 | 36.7 | 24.5 | 34.5 | 428 | 1 | 90792 99213 99214 99215 99223 99231 99232 99233 99238 99309 99443 | $46K |
| Nov 2020 | More hours than a day holds at a conservative unit price | 14.8 | 38.3 | 25.5 | 36.5 | 378 | 1 | 90792 99213 99214 99215 99223 99231 99232 99233 99238 99309 99443 | $41K |
| Dec 2020 | More hours than a day holds at a conservative unit price | 13.8 | 38.7 | 25.8 | 34.8 | 407 | 1 | 90792 99213 99214 99215 99223 99231 99232 99233 99238 99309 99443 | $46K |
| Jan 2021 | More hours than a day holds at a conservative unit price | 15.6 | 40.9 | 27.2 | 40.2 | 439 | 1 | 90792 99213 99214 99222 99223 99231 99232 99233 99238 99309 99443 | $51K |
| Feb 2021 | More hours than a day holds at a conservative unit price | 15.4 | 45.2 | 30.2 | 42.2 | 401 | 1 | 90792 99213 99214 99215 99223 99231 99232 99233 99238 99309 99443 | $50K |
| Mar 2021 | More hours than a day holds at a conservative unit price | 19.6 | 45.5 | 30.3 | 40.9 | 531 | 1 | 90792 99213 99214 99215 99222 99223 99231 99232 99233 99238 99309 99443 | $63K |
| May 2021 | More hours than a day holds at a conservative unit price | 15.7 | 36.6 | 24.4 | 36.0 | 482 | 1 | 90792 99213 99214 99215 99222 99223 99231 99232 99233 99238 99309 99443 | $52K |
| Jun 2021 | More hours than a day holds at a conservative unit price | 19.6 | 51.1 | 34.1 | 46.5 | 533 | 1 | 90792 99213 99214 99215 99223 99231 99232 99233 99238 99309 99310 99443 | $64K |
| Jul 2021 | More hours than a day holds at a conservative unit price | 19.0 | 41.5 | 27.7 | 39.0 | 518 | 1 | 90792 99213 99214 99215 99223 99231 99232 99233 99238 99309 99310 | $56K |
| Aug 2021 | More hours than a day holds at a conservative unit price | 20.2 | 47.0 | 31.3 | 44.2 | 514 | 1 | 90792 99213 99214 99215 99223 99231 99232 99233 99238 99309 99310 | $60K |
| Sep 2021 | More hours than a day holds at a conservative unit price | 19.9 | 45.7 | 30.5 | 41.6 | 553 | 1 | 90791 90792 99213 99214 99215 99223 99231 99232 99233 99238 99309 99310 | $62K |
| Oct 2021 | More hours than a day holds at a conservative unit price | 22.9 | 55.5 | 37.0 | 54.7 | 577 | 1 | 90791 90792 99213 99214 99215 99222 99223 99231 99232 99233 99238 99309 99310 | $74K |
| Nov 2021 | More hours than a day holds at a conservative unit price | 21.0 | 55.1 | 36.7 | 50.1 | 550 | 1 | 90791 90792 99213 99214 99215 99223 99231 99232 99233 99238 99309 | $68K |
| Dec 2021 | More hours than a day holds at a conservative unit price | 23.0 | 56.6 | 37.7 | 50.8 | 629 | 1 | 90791 90792 99213 99214 99222 99223 99231 99232 99233 99238 99309 | $74K |
| Jan 2022 | More hours than a day holds at a conservative unit price | 23.6 | 55.5 | 37.0 | 54.6 | 619 | 1 | 90792 99213 99214 99222 99223 99231 99232 99233 99238 99309 | $70K |
| Feb 2022 | More hours than a day holds, even counting one unit per claim line | 24.8 | 55.2 | 36.8 | 51.5 | 565 | 1 | 90791 90792 99213 99214 99223 99231 99232 99233 99238 99309 | $63K |
| Mar 2022 | More hours than a day holds at a conservative unit price | 20.6 | 50.7 | 33.8 | 45.6 | 558 | 1 | 90791 90792 99213 99214 99215 99223 99231 99232 99233 99238 99309 | $66K |
| Apr 2022 | More hours than a day holds at a conservative unit price | 20.2 | 54.7 | 36.4 | 52.1 | 507 | 1 | 90791 90792 99213 99214 99215 99223 99231 99232 99233 99238 99309 | $63K |
| May 2022 | More hours than a day holds at a conservative unit price | 21.9 | 58.3 | 38.9 | 54.8 | 552 | 1 | 90791 99213 99214 99215 99222 99223 99231 99232 99233 99238 99309 | $67K |
| Jun 2022 | More hours than a day holds at a conservative unit price | 21.6 | 56.7 | 37.8 | 51.5 | 541 | 1 | 90792 99213 99214 99223 99231 99232 99233 99238 99309 | $66K |
| Jul 2022 | More hours than a day holds at a conservative unit price | 20.0 | 57.3 | 38.2 | 56.3 | 528 | 1 | 90792 99213 99214 99215 99222 99223 99231 99232 99233 99238 99309 | $71K |
| Aug 2022 | More hours than a day holds at a conservative unit price | 20.5 | 55.0 | 36.7 | 49.4 | 546 | 1 | 90792 99213 99214 99215 99222 99223 99231 99232 99233 99238 99309 | $71K |
| Sep 2022 | More hours than a day holds at a conservative unit price | 16.6 | 52.0 | 34.6 | 47.2 | 470 | 1 | 90791 90792 99213 99214 99215 99223 99231 99232 99233 99238 99309 | $64K |
| Oct 2022 | More hours than a day holds at a conservative unit price | 18.3 | 53.6 | 35.8 | 52.8 | 494 | 1 | 90791 90792 99213 99214 99215 99222 99223 99231 99232 99233 99238 99309 | $68K |
| Nov 2022 | More hours than a day holds at a conservative unit price | 15.4 | 48.5 | 32.3 | 44.1 | 420 | 1 | 90791 90792 99213 99214 99215 99223 99231 99232 99233 99238 99309 | $59K |
| Dec 2022 | More hours than a day holds at a conservative unit price | 17.0 | 56.1 | 37.4 | 52.7 | 428 | 1 | 90792 99213 99214 99215 99223 99231 99232 99233 99238 99309 | $62K |
| Jan 2023 | More hours than a day holds at a conservative unit price | 19.7 | 63.1 | 42.1 | 59.3 | 498 | 1 | 90792 99213 99214 99215 99222 99223 99231 99232 99233 99238 99309 99310 | $71K |
| Feb 2023 | More hours than a day holds at a conservative unit price | 15.0 | 50.7 | 33.8 | 47.3 | 393 | 1 | 90792 99213 99214 99222 99231 99232 99233 99238 99309 | $52K |
| Mar 2023 | More hours than a day holds at a conservative unit price | 12.4 | 47.5 | 31.7 | 42.7 | 337 | 1 | 90792 99213 99214 99215 99222 99232 99233 99309 99310 | $51K |
| Apr 2023 | More hours than a day holds at a conservative unit price | 16.1 | 50.1 | 33.4 | 50.1 | 412 | 1 | 90792 99213 99214 99215 99222 99231 99232 99233 99238 99309 | $57K |
| May 2023 | More hours than a day holds at a conservative unit price | 15.2 | 47.3 | 31.5 | 42.5 | 416 | 1 | 90792 99213 99214 99215 99231 99232 99233 99238 99309 | $57K |
| Jun 2023 | More hours than a day holds at a conservative unit price | 15.8 | 51.3 | 34.2 | 46.6 | 448 | 1 | 90792 99213 99214 99223 99231 99232 99233 99238 99309 | $59K |
| Jul 2023 | More hours than a day holds at a conservative unit price | 15.2 | 54.6 | 36.4 | 53.8 | 416 | 1 | 90792 99213 99214 99222 99223 99231 99232 99233 99309 | $61K |
| Aug 2023 | More hours than a day holds at a conservative unit price | 11.1 | 46.4 | 30.9 | 41.7 | 303 | 1 | 90792 99213 99214 99232 99233 99309 | $50K |
| Sep 2023 | More hours than a day holds at a conservative unit price | 15.1 | 53.5 | 35.7 | 51.0 | 408 | 1 | 90792 99213 99214 99222 99231 99232 99233 99309 | $62K |
| Oct 2023 | More hours than a day holds at a conservative unit price | 17.7 | 59.2 | 39.4 | 55.6 | 519 | 1 | 90792 99213 99214 99222 99223 99231 99232 99233 99238 99309 | $72K |
| Nov 2023 | More hours than a day holds at a conservative unit price | 14.9 | 55.5 | 37.0 | 50.5 | 415 | 1 | 90792 99213 99214 99222 99231 99232 99233 99238 99309 | $63K |
| Dec 2023 | More hours than a day holds at a conservative unit price | 10.0 | 48.3 | 32.2 | 47.6 | 271 | 1 | 90792 99213 99214 99309 | $49K |
| Jan 2024 | More hours than a day holds at a conservative unit price | 9.8 | 44.7 | 29.8 | 40.2 | 228 | 1 | 90792 99213 99214 99309 | $47K |
| Feb 2024 | More hours than a day holds at a conservative unit price | 15.6 | 59.9 | 39.9 | 55.1 | 332 | 1 | 90792 99213 99214 99222 99231 99232 99233 99309 | $60K |
| Mar 2024 | More hours than a day holds at a conservative unit price | 14.2 | 56.5 | 37.6 | 55.6 | 336 | 1 | 90792 99213 99214 99231 99232 99233 99309 | $59K |
| Apr 2024 | More hours than a day holds at a conservative unit price | 16.6 | 62.3 | 41.5 | 56.7 | 431 | 1 | 90792 99213 99214 99223 99231 99232 99233 99238 99309 | $71K |
| May 2024 | More hours than a day holds at a conservative unit price | 19.4 | 67.6 | 45.1 | 60.8 | 456 | 1 | 90792 99213 99214 99222 99223 99231 99232 99233 99238 99309 | $77K |
| Jun 2024 | More hours than a day holds at a conservative unit price | 10.1 | 50.5 | 33.7 | 50.5 | 140 | 1 | 99213 99214 99231 99232 99233 99309 | $39K |
| Jul 2024 | More hours than a day holds at a conservative unit price | 13.1 | 57.6 | 38.4 | 51.7 | 242 | 1 | 90792 99213 99214 99222 99231 99232 99233 99309 | $50K |
| Aug 2024 | More hours than a day holds at a conservative unit price | 13.4 | 47.2 | 31.4 | 44.3 | 265 | 1 | 99213 99214 99223 99231 99232 99233 99238 99309 | $45K |
| Sep 2024 | More hours than a day holds at a conservative unit price | 13.6 | 48.0 | 32.0 | 45.7 | 253 | 1 | 99213 99214 99223 99231 99232 99233 99238 99309 | $44K |
| Oct 2024 | More hours than a day holds at a conservative unit price | 10.6 | 43.2 | 28.8 | 38.8 | 210 | 1 | 99213 99214 99223 99231 99232 99233 99238 99309 | $40K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | THRESA HELEN SIMON, M.D. |
| Type | Individual |
| Status | Active |
| NPI issued | April 20, 2006, last updated October 2, 2013 |
| Practice location | 269 MEDICAL PARK BLVD, Petersburg, VA 23805-9337, 804-861-0700 |
| Specialties | Psychiatry & Neurology, Psychiatry (2084P0800X, license 0101840405 VA) Psychiatry & Neurology, Child & Adolescent Psychiatry (2084P0804X, primary, license 0101840405 VA) |
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 | |
|---|---|---|---|---|---|---|---|
| 99309 | Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes | $1.6M | 34% | $506 | $21 (top 5% from $84) | 100th percentile | |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | $673K | 14% | $52 | $44 (top 5% from $110) | 61st percentile | |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $619K | 13% | $95 | $60 (top 5% from $133) | 82nd percentile | |
| 99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | $361K | 8% | $103 | $96 (top 5% from $249) | 55th percentile | |
| 90792 | Psychiatric diagnostic evaluation with medical services | $341K | 7% | $171 | $112 (top 5% from $313) | 79th percentile | |
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | $316K | 7% | $84 | $67 (top 5% from $174) | 66th percentile | |
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | $219K | 5% | $114 | $81 (top 5% from $170) | 77th percentile | |
| 99231 | Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes | $171K | 4% | $67 | $37 (top 5% from $103) | 83rd 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 |
|---|---|---|---|---|---|---|---|---|
| 99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | 156 | 74 | $13K | $250 | $111 | 2.3x | 2.6x (90th percentile 4.7x) |
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | 158 | 81 | $9K | $200 | $74 | 2.7x | 2.6x (90th percentile 4.3x) |
| 99231 | Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes | 214 | 78 | $8K | $150 | $46 | 3.3x | 2.4x (90th percentile 4.0x) |
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | 38 | 37 | $5K | $325 | $162 | 2.0x | 3.0x (90th percentile 5.6x) |
| 99238 | Hospital discharge day management, 30 minutes or less | 27 | 26 | $2K | $150 | $76 | 2.0x | 2.6x (90th percentile 4.7x) |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | 19 | 11 | $652 | $150 | $83 | 1.8x | 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
8 providers in Prince George County, VA carry an indicator in the public record, with $17.6M at stake between them. The most common is more hours than a day holds, on 7 of them, followed by part of a provider network on 1.
| tier | provider | at stake | why |
|---|---|---|---|
| 3 | HOPEWELL HEALTH CARE LLC Hopewell, VA, ranked 3991 | $0 |
|
| 4 | WALID FAWAZ Hopewell, VA, ranked 7516 | $3.6M |
|
| 4 | C. AMARA Petersburg, VA, ranked 7517 | $3.6M |
|
| 4 | RAKESH SHAH Hopewell, VA, ranked 7527 | $3.4M |
|
| 4 | SALMAN SIDDIQUI Hopewell, VA, ranked 7568 | $3.0M |
|
| 4 | MOHAMMAD IMTIAZ MUBBASHAR Petersburg, VA, ranked 9277 | $405K |
|
| 5 | DEVI VASU Petersburg, VA, ranked 9990 | $1.8M |
|
| 5 | ABDUL MOHIUDDIN Hopewell, VA, ranked 10853 | $1.7M |
Recent enforcement in VA
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
DOJChargedJun 23, 2026
U.S. Attorney’s Office announces charges against three defendants in the Eastern District of Virginia as part of national health care fraud takedown
Three defendants were charged with fraudulently billing Medicaid for mental health services that were not provided and with submitting false claims to Medicare through a straw-owned durable medical equipment company.
DOJSentencedJun 5, 2026
Medicaid service providers sentenced for false statements resulting in overbilling
Wright and Winfield instructed CCR employees to falsely claim in progress notes that children received therapeutic day treatment services from 2:00pm to 7:00pm, including providing prefilled progress note templates, resulting in overbilling to Medicaid.
DOJCivil settlementApr 27, 2026
Tri-Area Community Health Agrees to Pay $513,000 to Resolve Medicare Billing Allegations
Tri-Area Community Health billed Medicare for Annual Wellness Visits provided by pharmacists without appropriate physician supervision that were billed under the names of physicians not involved with the visits.
DOJSentencedMar 17, 2026
Six Sentenced in Healthcare Fraud Conspiracy that Stole $10 Million from Medicaid Over Six-Year Period
Six defendants conspired to submit false claims to Virginia Medicaid on behalf of 1st Adult N Pediatric Healthcare Services for nursing and personal care services that were not provided, including falsifying records and paying parents or guardians of patients for blank, signed nursing notes.
DOJIndictedMar 11, 2026
Victim Advisory- Divine Youth Case Updates
Divine Youth Counseling submitted more than $11 million in fraudulent Medicaid claims for Crisis Stabilization and Mobile Crisis services by falsely claiming two mental health professionals provided Team Treatment services and paid more than $470,000 in kickbacks in the form of hotel rooms for Medicaid recipients.
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.