Providers
All 76 in MD
RAYMOND E BANFER, MD
NPI 1093714057, individual, Cumberland, MD, Family Medicine
4
Evidence tier
structure or single-organization volume
- Hours beyond a day in 1 month under one organization, which can be supervisory billing.
- Records needed.
- Medicaid dollars per patient on code 99213 ($124 per patient-month) sit in the top 5% of every provider billing that code.
score 53 of 100, rank 8110, $30K 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 2020 | More hours than a day holds, even counting one unit per claim line | 30.5 | 5.3 | 3.5 | 4.8 | 391 | 2 | 99213 99214 | $30K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | RAYMOND E BANFER, MD |
| Type | Individual |
| Status | Active |
| NPI issued | July 20, 2005, last updated October 6, 2021 |
| Practice location | 621 KELLY RD, Cumberland, MD 21502-2878, 301-722-3270 |
| Mailing address | 109 RAYLOC DR, Hancock, MD 21750-1518 |
| Specialties | Family Medicine (207Q00000X, primary, license D0036371 MD) |
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 | |
|---|---|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $1.3M | 46% | $128 | $60 (top 5% from $133) | 94th percentile | |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | $942K | 33% | $124 | $44 (top 5% from $110) | 96th percentile | |
| T1015 | Medicaid service code | $342K | 12% | $114 | $182 (top 5% from $488) | 26th percentile | |
| 99215 | Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or morehistory of abuse | $93K | 3% | $141 | $88 (top 5% from $210) | 82nd percentile | |
| 99395 | Medicaid service code | $70K | 2% | $137 | $73 (top 5% from $138) | 95th percentile | |
| 99396 | Medicaid service code | $63K | 2% | $139 | $70 (top 5% from $132) | 97th percentile | |
| 99204 | New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more | $14K | 0% | $121 | $95 (top 5% from $171) | 72nd percentile | |
| 99385 | Medicaid service code | $7K | 0% | $132 | $74 (top 5% from $146) | too few months to rank |
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 |
|---|---|---|---|---|---|---|---|---|
| 87428 | Detection test by immunoassay technique for severe acute respiratory syndrome coronavirus and influenza | 70 | 67 | $5K | $66 | $65 | 1.0x | 1.9x (90th percentile 3.1x) |
| 83036 | Hemoglobin a1c level | 147 | 101 | $1K | $40 | $10 | 4.2x | 3.5x (90th percentile 6.9x) |
| 87880 | Detection test by immunoassay with direct visual observation for streptococcus, group a (strep) | 85 | 77 | $1K | $46 | $16 | 2.8x | 2.6x (90th percentile 4.1x) |
| 81003 | Automated urinalysis test | 229 | 157 | $504 | $19 | $2 | 8.6x | 4.6x (90th percentile 12.7x) |
| 93005 | Routine electrocardiogram (ecg) using at least 12 leads with tracing | 72 | 70 | $286 | $50 | $6 | 7.9x | 6.3x (90th percentile 18.0x) |
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
76 providers in MD carry an indicator in the public record, with $113.5M at stake between them. The most common is more hours than a day holds, on 53 of them, followed by named in an enforcement record on 8. 11 are tier 1: documented action, then payment.
| tier | provider | at stake | why |
|---|---|---|---|
| 1 | ELIA TORRES Takoma Park, MD, ranked 25 | $14K |
|
| 1 | GUIDING LIVES Baltimore, MD, ranked 57 | $1.4M |
|
| 1 | ANOTHER CHANCE SUPPORTIVE SERVICES Baltimore, MD, ranked 67 | $874K |
|
| 1 | QOL COMMUNICATION SERVICES, LLC Owings Mills, MD, ranked 73 | $729K |
|
| 1 | AMSTRONG CHAPAJONG Glenarden, MD, ranked 109 | $232K |
|
| 1 | LABORATORY RX, LLC Frederick, MD, ranked 131 | $132K |
|
| 1 | ADAM MEDICAL EQUIPMENT INC Frederick, MD, ranked 168 | $66K |
|
| 1 | RICHARD O AKOTO MD PA Takoma Park, MD, ranked 510 | $0 |
|
Recent enforcement in MD
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
DOJCivil settlementMar 20, 2026
Health Care Management Corporation Agrees to Pay $4 Million to Resolve False Claims Act Allegations
CVR knowingly submitted claims to Medicare, Medicaid, and TRICARE for sclerotherapy, radiofrequency ablation, and endovenous laser ablation procedures to treat chronic venous insufficiency that were not clinically indicated and were medically unnecessary between January 1, 2010, and December 31, 2016.
DOJCivil settlementNov 20, 2025
Diagnostic Laboratory Agrees to Pay More Than $1 Million to Settle Alleged False Claims Act Violations
GTI agreed to pay $1.635 million to resolve allegations that it submitted Medicare claims for respiratory pathogen panels that were medically unnecessary or obtained through kickbacks paid under a marketing services agreement with an infection prevention company for laboratory test referrals from long-term care facilities.
DOJSentencedNov 13, 2025
Baltimore County Woman Sentenced for Impersonating Nurses and Aggravated Identity Theft
Amponsah used stolen nursing licenses and false educational and professional histories to obtain employment as a purported licensed nurse at no less than 40 facilities in Maryland that billed health care benefit programs including Medicare and Medicaid for services she provided, earning more than $145,000 in wages.
DOJPleaded guiltyAug 14, 2025
Baltimore County Woman Admits to Impersonating Nurses, Pleads Guilty to Aggravated Identity Theft
Amponsah used stolen nursing licenses and false educational and professional histories to obtain employment as a purported licensed nurse at no less than 40 facilities in Maryland, which billed health care benefit programs including Medicare and Medicaid for services she provided.
DOJCivil judgmentAug 11, 2025
United States Obtains More Than $1.4 Million Judgment Against Family Medical Practitioner for Fraudulent Billing
Akoto billed Medicare for auricular stimulation (P-Stim) devices using a code for a surgically implanted neurostimulator device, which Medicare does not reimburse as acupuncture.
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.