Providers
All 10 in IL
GERTHY CIPUS PIERRE
NPI 1083126353, individual, O Fallon, IL, Nurse Practitioner, Psych/Mental Health
5
Evidence tier
informational
- Medicaid dollars per patient on code 99345 ($812 per patient-month) sit in the top 5% of every provider billing that code.
score 34 of 100, rank 10496, $51K at stake
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | GERTHY CIPUS PIERRE |
| Type | Individual, sole proprietor |
| Status | Active |
| NPI issued | October 26, 2017, last updated March 2, 2026 |
| Practice location | 9 EAGLE CTR STE 3, O Fallon, IL 62269-1948, 618-954-7434 |
| Mailing address | 1706 CLOVERDALE DR, Edwardsville, IL 62025-5500 |
| Specialties | Nurse Practitioner, Psych/Mental Health (363LP0808X, license 2013038384 MO) Nurse Practitioner, Family (363LF0000X, license 1014759 TX) Nurse Practitioner, Family (363LF0000X, license 0192721 IL) Nurse Practitioner, Psych/Mental Health (363LP0808X, primary, license 2023125387 IL) |
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 | |
|---|---|---|---|---|---|---|---|
| 99345 | Residence visit for new patient with high level of medical decision making, per day, if using time, at least 75 minutes | $1.3M | 85% | $812 | $132 (top 5% from $483) | 98th percentile | |
| 99350 | Residence visit for established patient with high level of medical decision making, per day, if using time, at least 60 minutes | $75K | 5% | $535 | $37 (top 5% from $218) | 99th percentile | |
| 96127 | Assessment of emotional or behavioral problems | $63K | 4% | $33 | $4.12 (top 5% from $19) | 98th percentile | |
| 90791 | Psychiatric diagnostic evaluation | $20K | 1% | $158 | $105 (top 5% from $228) | 85th percentile | |
| 99501 | Medicaid service code | $19K | 1% | $165 | $77 (top 5% from $210) | 90th percentile | |
| 83037 | Hemoglobin a1c level, by device for home use | $11K | 1% | $62 | $2.73 (top 5% from $15) | 100th percentile | |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | $7K | 0% | $42 | $44 (top 5% from $110) | 47th percentile | |
| 36416 | Medicaid service code | $6K | 0% | $36 | $0.40 (top 5% from $5.45) | 100th percentile |
In this area
10 providers in St. Clair County, IL carry an indicator in the public record, with $1.3M at stake between them. The most common is part of a provider network, on 8 of them, followed by more hours than a day holds on 1.
| tier | provider | at stake | why |
|---|---|---|---|
| 3 | BRIA OF MASCOUTAH LP Mascoutah, IL, ranked 2197 | $0 |
|
| 3 | CASEYVILLE NURSING & REHABILITATION CENTER INC. Caseyville, IL, ranked 3407 | $0 |
|
| 3 | CAHOKIA NURSING AND REHABILITATION CENTER Cahokia, IL, ranked 3918 | $0 |
|
| 3 | BREEZE OPERATIONS, LLC Shiloh, IL, ranked 4388 | $0 |
|
| 3 | BELLEVILLE HEALTHCARE CENTER LP Belleville, IL, ranked 5366 | $0 |
|
| 3 | ATRIUM HEALTH CARE & REHABILITATION CENTER OF CAHOKIA L.P Cahokia, IL, ranked 6009 | $0 |
|
| 3 | ST PAULS SENIOR COMMUNITY LLC Belleville, IL, ranked 6788 | $0 |
|
| 3 | BELLEVILLE HEALTHCARE & REHAB CENTER Belleville, IL, ranked 6997 | $0 |
|
Recent enforcement in IL
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
DOJChargedJun 23, 2026
United States Attorney Andrew S. Boutros Announces Charges Against Two Chicago-Area Defendants as Part of Department of Justice’s National Healthcare Fraud Takedown
Two Chicago-area defendants were charged, one for selling Medicare beneficiary information and providing fake AI-generated consent recordings so laboratories could bill Medicare for over-the-counter Covid-19 test kits that were never requested or provided, and the other for directing the creation of fake medical records and billing Illinois Medicaid for behavioral health counseling and therapy services that were never provided, including for deceased beneficiaries.
DOJConvictedJun 18, 2026
Suburban Chicago Chiropractor Convicted of Healthcare Fraud
A chiropractor submitted fraudulent claims to Blue Cross Blue Shield of Illinois for health care services that were not actually provided and submitted false patient medical records when the insurer attempted to audit the claims.
DOJSentencedJun 10, 2026
Jacksonville Chiropractor Sentenced to a Year in Prison for Healthcare Fraud and Related Offenses
Rondeau submitted more than 2,000 fraudulent claims to health insurance companies and convinced clients to sign false documents after learning he was under investigation.
DOJCivil settlementMay 8, 2026
Three Affiliated Skilled Nursing Facilities to Pay $300,000 to Resolve False Claims Act Allegations Related to Medically Unnecessary Rehabilitation Services
Three affiliated skilled nursing facilities billed Medicare between Jan. 1, 2014, and Sept. 30, 2019, for physical therapy, occupational therapy, and speech pathology services provided to patients for longer than medically necessary and without regard for patients' individual medical needs, resulting in claims based on inflated RUG levels.
DOJIndictedFeb 12, 2026
Two Foreign Nationals Indicted in Chicago as Part of $10 Million Health Care Fraud Scheme
The indictment alleges the defendants used nominee-owned laboratories and durable medical equipment providers to submit fraudulent claims to Medicare and private health care benefit programs for items and services that were not provided, and laundered and transferred proceeds to Pakistan.
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.