Providers
All 10 in ID
BRIAN RAYMOND, LCSW
NPI 1043468903, individual, Star, ID, Social Worker, Clinical
5
Evidence tier
informational
- Medicaid dollars per patient on code T1013 ($549 per patient-month) sit in the top 5% of every provider billing that code.
score 36 of 100, rank 9899, $4.5M at stake
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | BRIAN RAYMOND, LCSW |
| Type | Individual |
| Status | Active |
| NPI issued | September 4, 2008, last updated August 21, 2016 |
| Practice location | 10022 W DYLAN CT, Star, ID 83669-5643, 208-571-2723 |
| Specialties | Social Worker, Clinical (1041C0700X, primary, license LCSW 32132 ID) |
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 | |
|---|---|---|---|---|---|---|---|
| T1013 | Sign language or oral interpretive services per 15 min | $2.5M | 42% | $549 | $20 (top 5% from $260) | 99th percentile | |
| H0038 | Self-help/peer services per 15 min | $1.7M | 27% | $437 | $147 (top 5% from $2K) | 79th percentile | |
| T1017 | Targeted case management each 15 min | $760K | 13% | $252 | $167 (top 5% from $808) | 62nd percentile | |
| 90834 | Psychotherapy, 45 minutes | $571K | 9% | $197 | $101 (top 5% from $318) | 84th percentile | |
| T1016 | Case management each 15 min | $247K | 4% | $261 | $98 (top 5% from $507) | 81st percentile | |
| H2017 | Psychosocial rehabilitation services per 15 minhistory of abuse | $86K | 1% | $560 | $310 (top 5% from $1K) | 74th percentile | |
| H0032 | Medicaid service code | $79K | 1% | $93 | $98 (top 5% from $675) | 48th percentile | |
| T2002 | Medicaid service code | $64K | 1% | $32 | $181 (top 5% from $437) | 16th percentile |
In this area
10 providers in Ada County, ID carry an indicator in the public record, with $8.5M at stake between them. The most common is more hours than a day holds, on 6 of them, followed by part of a provider network on 3.
| tier | provider | at stake | why |
|---|---|---|---|
| 3 | LIGHTHOUSE HOSPICE LLC Meridian, ID, ranked 2269 | $0 |
|
| 3 | FIRST CHOICE HOME CARE, INC. Boise, ID, ranked 4162 | $0 |
|
| 3 | A BETTER WAY HOME, LLC Boise, ID, ranked 5407 | $0 |
|
| 4 | ZACHARIAH JENSEN Boise, ID, ranked 9412 | $252K |
|
| 5 | TYE KILLIAN Boise, ID, ranked 9957 | $2.2M |
|
| 5 | MAI PROVENCIO Boise, ID, ranked 9988 | $1.8M |
|
| 5 | TAMI JONES Boise, ID, ranked 10034 | $1.5M |
|
| 5 | ROSALIE LYNCH Eagle, ID, ranked 10128 | $909K |
|
Recent enforcement in ID
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
DOJCivil settlementOct 29, 2024
Boise Health Care Company and Former Therapist Resolve Fraudulent Psychotherapy Billing Allegations Involving Vulnerable Refugee Population
KA Health Services and its owner paid $321,576.51 to resolve allegations they submitted false Medicaid claims for psychotherapy, language interpretation, and other services that were never provided or not provided by a qualified professional, and a former counselor consented to a $40,000 judgment after admitting she directed unqualified interpreters to meet with refugee clients and signed false medical records.
DOJCivil settlementApr 3, 2024
Pocatello Doctor Pays $96,000 to Settle Allegations That He Wrote Unlawful Prescriptions
The government alleged that Knouf wrote prescriptions for controlled substances that lacked a legitimate medical purpose and/or were issued outside the usual course of professional practice, prescribed dangerous combinations of drugs, and billed Medicare and Medicaid for services that were not performed.
DOJCivil judgmentJan 17, 2024
AmeriHealth Clinics Consent to a $2 Million Judgment to Resolve Healthcare Fraud Allegations
AmeriHealth and its owners hired vulnerable, compromised, and inexperienced medical staff who were pressured into providing unnecessary and worthless care, resulting in false claims to federal health care programs, and also allegedly pressured practitioners to prescribe controlled substances, entered a kickback scheme with a third-party laboratory, and falsely certified information to obtain PPP loan forgiveness.
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.