PATRICK JOSEPH WAGNER, LCSW

NPI 1053680082, individual, Louisville, KY, Social Worker, Clinical

Evidence tier

structure or single-organization volume

Hours beyond a day in 4 months, but with up to 608 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 H2018 ($7694 per patient-month) sit in the top 5% of every provider billing that code.

score 55 of 100, rank 7776, $1.3M 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
Sep 2019	More hours than a day holds, even counting one unit per claim line	35.4	33.8	22.6	22.9	523	1	90832 90834 90837 90847 99354 H2015	$73K
Oct 2019	More hours than a day holds, even counting one unit per claim line	33.8	36.4	24.3	24.2	529	1	90832 90834 90837 90847 99354 H2015	$81K
Nov 2019	More hours than a day holds, even counting one unit per claim line	29.0	31.9	21.3	22.4	519	1	90832 90834 90837 90847 99354 H2015	$69K
Jan 2020	More hours than a day holds, even counting one unit per claim line	36.6	36.3	24.2	26.4	608	1	90832 90834 90837 90847 99354 H2015	$83K

National provider registry

From the CMS NPPES Registry, refreshed daily.

Name	PATRICK JOSEPH WAGNER, LCSW
Type	Individual
Status	Active
NPI issued	December 20, 2011, last updated February 5, 2024
Practice location	1015 DORSEY LN, Louisville, KY 40223-2612, 502-245-1576
Specialties	Social Worker, Clinical (1041C0700X, primary, license 3950 KY)

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
H2018	Psychosocial rehabilitation services per diem	$20.0M	88%	$8K	$1K (top 5% from $5K)	100th percentile
H2021	Community-based wrap-around services per 15 min	$886K	4%	$1K	$845 (top 5% from $4K)	59th percentile
90837	Psychotherapy, 1 hourhistory of abuse	$677K	3%	$157	$191 (top 5% from $442)	34th percentile
H2015	Comprehensive community support services per 15 minhistory of abuse	$413K	2%	$294	$344 (top 5% from $2K)	46th percentile
H0032	Medicaid service code	$135K	1%	$67	$98 (top 5% from $675)	28th percentile
H0031	Medicaid service code	$108K	0%	$56	$100 (top 5% from $540)	29th percentile
90834	Psychotherapy, 45 minutes	$94K	0%	$62	$101 (top 5% from $318)	25th percentile
99354	Prolonged service outpatient first hour (retired 2023)	$84K	0%	$105	$78 (top 5% from $222)	65th percentile

In this area

59 providers in Jefferson County, KY carry an indicator in the public record, with $99.8M at stake between them. The most common is more hours than a day holds, on 45 of them, followed by paid after a public list action on 6. 4 are tier 1: documented action, then payment.

tier	provider	at stake	why
1	MAJA CUPAC Louisville, KY, ranked 65	$9K	Listed on the KY Medicaid exclusion list since April 22, 2022. Medicaid still paid claims in 4 later months, $8,911 in total. and 1 more
1	BAKER CHIROPRACTIC CENTER PSC Louisville, KY, ranked 139	$119K	Listed on the KY Medicaid exclusion list and the Medicare revocation list since January 4, 2024. Medicaid still paid claims in 10 later months, $119,249 in total.
1	MICHAEL BAKER Louisville, KY, ranked 140	$119K	Listed on the Medicare revocation list and the KY Medicaid exclusion list since January 4, 2024. Medicaid still paid claims in 10 later months, $119,249 in total.
1	JORDAN EDELEN Louisville, KY, ranked 261	$14K	Listed on the KY Medicaid exclusion list and the Medicare revocation list since December 16, 2019. Medicaid still paid claims in 9 later months, $14,032 in total.
3	CHRISTIAN BERKHAHN Louisville, KY, ranked 1301	$161K	Charged (charged) per a Department of Justice release dated June 23, 2026, not adjudicated. Medicaid paid $161,424 in the last 12 observed months.
3	LAWRENCE PETERS Louisville, KY, ranked 1509	$16K	Charged (charged) per a Department of Justice release dated June 27, 2024, not adjudicated. Medicaid paid $16,372 in the last 12 observed months.
3	MATTHEW ELKINS Louisville, KY, ranked 1571	$7K	Charged (charged) per a Department of Justice release dated July 1, 2025, not adjudicated. Medicaid paid $6,952 in the last 12 observed months.
3	LOUISVILLE KY OPCO LLC Louisville, KY, ranked 1885	$0	Part of provider network D1-00087, ranked 87 nationally.

All 59 in KY

Recent enforcement in KY

All releases

Department of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.

DOJIndictedAug 27, 2026

Kentucky Medical Biller Indicted for Healthcare Fraud and Money Laundering Charges

Sanders recruited individuals to open behavioral health entities, handled their Kentucky Medicaid credentialing and enrollment, and directed submission of fraudulent Medicaid claims across ten behavioral health providers for services never provided, including for incarcerated, hospitalized, or deceased members, using licensed professionals' NPIs without authorization.

DOJChargedJun 23, 2026

5 Individuals and 2 Companies Charged as Part of Department of Justice National Health Care Fraud Takedown

Seven defendants were charged in four cases with schemes including billing Kentucky Medicaid for peer support and psychoeducation services that were fraudulent, unauthorized, or not rendered using providers' NPIs, using a DEA number to order controlled substances in others' names, credentialing a company with Medicare and billing for services not rendered using a doctor's NPI, and stealing controlled substances from hospitals and falsely documenting administration.

DOJCivil settlementJun 23, 2026

Civil Settlements Reached as Part of Department of Justice National Health Care Fraud Takedown

Three Home and Community Based Waiver providers and their owners, who had shared financial interests, referred Medicaid waiver beneficiaries for attendant care services and billed Medicaid for attendant care hours that were not fully provided or not provided at all.

DOJCivil judgmentMay 15, 2026

Operators of Day Treatment Program for Children Agree to $15.2 Million Civil Judgment to Resolve Medicaid Fraud Allegations

The Government alleged that from August 2022 through June 2025 the Recovery Centers sought Medicaid payments for time children spent on education, recreation, and lunch breaks at the Aspire Day Program and that Recovery Center of Kentucky falsely represented clinician qualifications to obtain higher reimbursements.

DOJSentencedApr 24, 2026

Former Sober Home Owner and Operator Sentenced for Kickback Conspiracy and Health Care Fraud

Jordan solicited and received kickbacks in exchange for referring urine drug testing from her sober home company to three labs, and Serenity Keepers billed Medicaid for peer support services not provided by licensed peer support specialists, with Williams reporting that residents received six hours of peer support services per day knowing that was not true.

Referral packet

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