CASEY LAWRENCE STELTER, MD

Casey Stelter is an individual provider registered in Layton, Utah, with a family medicine style taxonomy and Utah as the Medicaid home state. In one month, November 2024, the therapy and speech services billed under this provider add up to roughly 4.7 hours of hands-on time per clinician per calendar day, and those lines were submitted through three different billing organizations. That single month accounts for $30,145 in payments. Separately, the Medicaid records show two office visit codes making up about two thirds of this provider's Medicaid dollars at rates per patient-month above the typical level for other providers billing the same codes, and two other codes that paid large amounts inside very short windows. None of this shows that anything improper happened, and the reviewer should first confirm who actually performed and supervised the services.

1. 01National Provider Identifier 1073607222 belongs to Casey Stelter, an individual provider in Layton, Utah, with taxonomy 207Q00000X and Utah listed as the Medicaid home state. records 1
2. 02The risk record places this provider at evidence tier 2 for impossible volume with concurrency, names detector D2, lists dollars at risk of $30,145, and states that the provider billed more hands-on hours than a day holds in one month, peaking at 4.7 hours per day across three billing organizations. records 12
3. 03The flag dated November 1, 2024 is labeled impossible by line count, shows implied hours per clinician per calendar day for personal services of 4.7 with a lower bound of 36.6 and a point value of 8.5, $30,145 in payment, three billing organizations, and codes 92507, 97110, 97112, 97116, 97140, 97530 and 97535, with rates taken from the median per line source. records 13
4. 04Medicaid code 99214, established patient office visit with moderate level of decision making, paid $126,067 over 55 months, 33 percent of this provider's Medicaid dollars, at $91 per patient-month, ranking at the 80th percentile of all providers billing this code where the typical figure is $60. records 2
5. 05Medicaid code 99213, established patient office visit with low level of decision making, paid $118,480 over 57 months, 31 percent of this provider's Medicaid dollars, at $71 per patient-month, ranking at the 82nd percentile of all providers billing this code where the typical figure is $44. records 3
6. 06Medicaid code T2046 paid $69,137 over 2 months, 18 percent of this provider's Medicaid dollars, at $2,765 per patient-month. records 4
7. 07Medicaid code 97530, therapy procedure using functional activities, paid $18,968 over 1 month, 5 percent of this provider's Medicaid dollars, at $164 per patient-month. records 5
8. 08Medicaid nursing facility codes 99309 and 99306 paid $15,559 over 17 months and $13,958 over 15 months, at the 51st and 53rd percentiles respectively, close to the typical dollars per patient-month for those codes. records 6, 7
9. 09In Medicare 2024, code 99490 for chronic care management shows 1,815 services for 449 beneficiaries and $81,374 paid, with a submitted to allowed ratio of 1.8 times against a usual ratio of 1.8 times. records 8
10. 10In Medicare 2024, code 99309 shows 998 services for 409 beneficiaries and $79,759 paid, and code 99306 shows 259 services for 210 beneficiaries and $35,526 paid, both with submitted to allowed ratios below the usual ratio for those codes. records 9, 11
11. 11In Medicare 2024, code 99214 shows 493 services for 174 beneficiaries and $38,485 paid, with a submitted to allowed ratio of 1.5 times against a usual ratio of 2.3 times. records 10

Request from the three billing organizations the complete claim detail, treatment notes, appointment schedules and staff time records for the November 2024 dates covering codes 92507, 97110, 97112, 97116, 97140, 97530 and 97535, so the implied 4.7 hours per clinician per calendar day can be tested against actual rendering staff. Obtain rendering and supervising provider assignments and any locum or incident to arrangements to confirm whether services attributed to this National Provider Identifier were personally performed. Request the underlying documentation for Medicaid code T2046, which paid $69,137 across two months, and for code 97530, which paid $18,968 in one month, along with medical records supporting the level of decision making billed for codes 99213 and 99214. Verify enrollment and screening status under 42 CFR 455.410, including whether revalidation has occurred within five years. If the time verification is not resolved by the records, refer to the Medicaid Fraud Control Unit under 42 CFR 455.23(d) and evaluate payment suspension and good cause under 42 CFR 455.23(a); if a claims review shows services not provided as claimed, evaluate civil monetary penalty exposure under 42 CFR 1003.200.

• The provider identifier may have been used as a supervising or billing identifier for services performed by therapists or clinical staff, which is a common convention and would explain hours that exceed one person's day.
• Three billing organizations appear on the same day, so a shared billing agent, a group practice arrangement or a shared address or landlord could cause claims from multiple clinicians to roll up to one identifier.
• The implied hours figure is derived from median per line rate assumptions and shows a wide range from a lower bound of 36.6 to a point value of 8.5, so the underlying time estimate may change once actual units and rendering staff are confirmed.
• Short duration codes such as T2046 and 97530 may reflect a limited program, a retroactive payment or a settlement rather than ongoing billing, and claims data lag can compress payments into a small number of months.
• The dollars at risk figure of $30,145 is the output of the detector that set the tier and is not a sum of overpayments.
• The percentile rankings for office visit codes reflect dollars per patient-month and may be explained by a sicker or more complex panel, and the Medicare submitted to allowed ratios for several codes are at or below the usual ratio.
• Prior appeals, reinstatements or corrected claims may already have adjusted some of the payments described here.