OTTO MICHAEL BERK, LCSW

NPI 1225033525, individual, Forest Hills, NY, Social Worker, Clinical

Evidence tier

impossible volume with concurrency

Billed more hands-on hours than a day holds in 6 months, peaking at 26.4 hours per day across 3 billing organizations.

score 81 of 100, rank 728, $1.2M 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
May 2019	More hours than a day holds, even counting one unit per claim line	32.9	36.8	24.5	33.0	206	1	90876 H0004	$154K
Jun 2019	More hours than a day holds, even counting one unit per claim line	35.8	37.9	25.3	37.9	182	1	90876 H0004	$140K
Jul 2019	More hours than a day holds, even counting one unit per claim line	35.9	34.9	23.2	31.3	220	1	90837 90876 H0004	$133K
Aug 2019	More hours than a day holds, even counting one unit per claim line	28.0	25.0	16.7	23.5	201	1	90837 90876 H0004	$99K
Feb 2023	More hours than a day holds, even counting one unit per claim line	28.8	32.1	21.4	29.9	121	1	90876	$103K
Mar 2023	More hours than a day holds, even counting one unit per claim line	36.9	39.6	26.4	35.6	126	1	90876	$141K

National provider registry

From the CMS NPPES Registry, refreshed daily.

Name	OTTO MICHAEL BERK, LCSW
Type	Individual, sole proprietor
Status	Active
NPI issued	June 15, 2005, last updated February 15, 2011
Practice location	6762 BURNS ST, Forest Hills, NY 11375-3537, 718-544-5522
Specialties	Social Worker, Clinical (1041C0700X, primary, license R-042031 NY)

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
90876	Psychophysiological therapy with biofeedback 45 min	$1.3M	73%	$587	$392 (top 5% from $816)	79th percentile
H0004	Behavioral health counseling and therapy per 15 minhistory of abuse	$365K	21%	$331	$174 (top 5% from $559)	84th percentile
90837	Psychotherapy, 1 hourhistory of abuse	$60K	3%	$81	$191 (top 5% from $442)	10th percentile
H0031	Medicaid service code	$33K	2%	$187	$100 (top 5% from $540)	77th percentile
Q3014	Telehealth originating site facility fee	$6K	0%	$20	$21 (top 5% from $84)	46th percentile
90901	Biofeedback training	$5K	0%	$107	$45 (top 5% from $503)	too few months to rank
90791	Psychiatric diagnostic evaluation	$3K	0%	$87	$105 (top 5% from $228)	too few months to rank
H0002	Medicaid service code	$815	0%	$21	$34 (top 5% from $215)	too few months to rank

In this area

77 providers in Queens County, NY carry an indicator in the public record, with $133.2M at stake between them. The most common is more hours than a day holds, on 58 of them, followed by named in an enforcement record on 8. 9 are tier 1: documented action, then payment.

tier	provider	at stake	why
1	JAEWOOK CHOI Bayside, NY, ranked 170	$63K	Listed on the Medicare revocation list since March 31, 2023. Medicaid still paid claims in 7 later months, $63,142 in total.
1	JAEKWAN LEE Flushing, NY, ranked 198	$45K	Adjudicated (pleaded guilty) per a Department of Justice release dated May 12, 2026. Medicaid paid $44,912 in the last 12 observed months.
1	KRISTINE MAY PARCON Forest Hills, NY, ranked 220	$32K	Listed on the Medicare revocation list since September 6, 2023. Medicaid still paid claims in 5 later months, $31,675 in total.
1	JUAN A MEDINA MEDICAL OFFICE PC Far Rockaway, NY, ranked 246	$19K	Listed on the NY Medicaid exclusion list since December 8, 2014. Medicaid still paid claims in 4 later months, $19,325 in total.
1	ELIZABETH YUABOV Rego Park, NY, ranked 304	$7K	Listed on the NY Medicaid exclusion list since February 12, 2020. Medicaid still paid claims in 7 later months, $7,470 in total.
1	BROOKLYN DOC MEDICAL P.C. Forest Hills, NY, ranked 332	$4K	Listed on the Medicare revocation list since November 4, 2022. Medicaid still paid claims in 5 later months, $4,091 in total.
1	JWC PT PC Bayside, NY, ranked 336	$4K	Listed on the Medicare revocation list since March 31, 2023. Medicaid still paid claims in 2 later months, $3,915 in total.
1	GLOBAL REHABILITATION MEDICAL PC Rego Park, NY, ranked 390	$1K	Listed on the NY Medicaid exclusion list since October 21, 2020. Medicaid still paid claims in 1 later month, $1,131 in total.

All 77 in NY

Recent enforcement in NY

All releases

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

DOJIndictedAug 20, 2026

Four Members Of The “War Room” Charged In Connection With $12 Million Medicaid Fraud Scheme

Members of a Bronx-based racketeering organization known as the "War Room" fabricated ride data for methadone clinic transportation using a GPS spoofing application, paid Medicaid patients kickbacks in cash and drugs for their enrollment information, provided the fake data to transportation companies that submitted over $12 million in claims to Medicaid, and laundered the proceeds.

DOJIndictedAug 20, 2026

Four Members of the “War Room” Charged in Connection with $12M Medicaid Fraud Scheme

Four members of a Bronx racketeering organization known as the "War Room" fabricated medical transportation ride data using a ride-tracking app and GPS spoofing, paid Medicaid patients at methadone clinics kickbacks in cash and drugs for their enrollment information, provided the fake data to transportation companies that submitted over $12 million in Medicaid claims, and laundered the proceeds.

DOJCivil settlementAug 17, 2026

Safire nursing homes agree to pay $9 million to resolve fraudulent Medicare and Medicaid billing allegations

The United States alleged that Safire submitted false claims to Medicare and Medicaid for skilled rehabilitative therapy services that were not reasonable or necessary, not supported by medical records, not documented as provided, or not provided at all, including by scheduling therapy based on insurer reimbursement policies, pressuring therapists and residents, and manufacturing or altering therapy referrals and medical records.

DOJSentencedJul 21, 2026

Owner of Long Island Ambulette Services Company Sentenced to Prison for Multimillion Dollar Healthcare Fraud Scheme

Arshad and co-conspirators paid kickbacks to Medicaid beneficiaries to order transportation through his companies and billed Medicaid over $19 million for medical transportation rides that were not provided, including for individuals who were deceased, hospitalized or incarcerated, and inflated reimbursements with false pickup addresses and distant treatment centers.

DOJIndictedJul 2, 2026

Two Defendants Charged with Multi-Million Dollar Health Care Fraud Scheme

The defendants, who owned and operated Tri-Hamlet Taxi Inc., allegedly paid kickbacks to Medicaid beneficiaries and submitted more than $35 million in claims to Medicaid for ambulette trips that were not provided or whose costs were inflated by using false pickup or drop-off addresses.

Referral packet

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