KIUP ALEXANDER KIM, MD, RPVI

Kiup Kim is an individual provider in Phoenix, Arizona, with National Provider Identifier 1225242985 and a vascular surgery taxonomy, whose Medicaid home state is Arizona. California listed this provider on its Medi-Cal Suspended and Ineligible Provider List on December 10, 2018. Medicaid records show payments continuing after that date, totaling $2,046,769 over 52 service months between January 2019 and August 2023, compared with $205,683 in the twelve months before the listing. More than half of this provider's Medicaid dollars came from one vein laser destruction code, and two vein ultrasound codes rank at the 77th and 90th percentile of all providers billing them, with per patient-month amounts several times the typical figure. These are records observations only, and the reviewer should confirm whether the California listing applies to the paying state program and whether the listing was ever appealed or lifted.

1. 01The subject is an individual provider, National Provider Identifier 1225242985, Kiup Kim, of Phoenix, Arizona, with taxonomy 208600000X and Medicaid home state Arizona. records 1
2. 02Records show the provider listed on the California Medicaid exclusion list since December 10, 2018, with Medicaid still paying claims in 52 later months totaling $2,046,769. records 9
3. 03After the California state exclusion action dated December 10, 2018, recorded on the California Medi-Cal Suspended and Ineligible Provider List dated July 2026, Medicaid paid $2,046,769 across 52 service months from January 2019 to August 2023, compared with $205,683 in the 12 months before. records 10
4. 04Procedure code 36478, laser destruction of an incompetent vein of the arm or leg using imaging guidance, accounts for $1,220,774 paid over 44 months, 54 percent of this provider's Medicaid dollars, at $983 per patient-month, which ranks at the 28th percentile of all providers billing this code against a typical $1,305. records 2
5. 05Procedure code 93970, ultrasound study of arm or leg veins with compression and maneuvers, accounts for $274,714 paid over 57 months, 12 percent of this provider's Medicaid dollars, at $106 per patient-month, which ranks at the 77th percentile against a typical $36. records 3
6. 06Procedure code 93971, ultrasound study of one arm or leg veins with compression and maneuvers, accounts for $148,432 paid over 39 months, 7 percent of this provider's Medicaid dollars, at $103 per patient-month, which ranks at the 90th percentile against a typical $18. records 5
7. 07Procedure code 36471, injection of a chemical agent into multiple incompetent veins of the leg, accounts for $138,283 paid over 27 months, 6 percent of this provider's Medicaid dollars, at $247 per patient-month, which ranks at the 92nd percentile against a typical $147. records 6
8. 08Procedure code 36465, injection of a chemical agent into a single incompetent vein of the leg using ultrasound guidance, accounts for $227,187 paid over 13 months, 10 percent of this provider's Medicaid dollars, at $1,023 per patient-month, which ranks at the 36th percentile against a typical $1,215. records 4
9. 09Procedure code 36482, chemical destruction of the first incompetent vein of the arm or leg using imaging guidance, accounts for $62,052 paid over 2 months, 3 percent of this provider's Medicaid dollars, at $2,068 per patient-month. records 7
10. 10In Medicare 2024 data, procedure code 93971 shows 15 services for 14 beneficiaries and $1,336 paid, with $342 submitted per service against $112 allowed, a ratio of 3.1 times where the usual ratio for this code is 4.2 times. records 8
11. 11The risk record assigns evidence tier 1, documented action followed by payment, detector D3, with dollars at risk of $2,046,769, described as the figure of the detector that set the tier rather than a sum. records 9

Request the Arizona Medicaid enrollment and revalidation file for National Provider Identifier 1225242985, including all screening results, and confirm identity and exclusion status through routine checks of the Social Security Death Master File, the National Plan and Provider Enumeration System, the List of Excluded Individuals and Entities and the System for Award Management, as required by 42 CFR 455.436, which also requires those last two checks no less frequently than monthly. Verify against the termination database whether this provider appears as terminated under Medicare or under the Medicaid program or CHIP of another state, since 42 CFR 455.416(c) requires the state agency to deny or terminate enrollment of a provider terminated on or after January 1, 2011 and included in that database. Obtain from California the full listing record, the effective date, the basis for the listing and any appeal, reinstatement or removal history, and confirm whether the listing is a termination for cause or another status. Pull the paid claims detail for the 52 service months from January 2019 through August 2023, including rendering and billing identifiers, to establish whether payments were made to this individual or through a group arrangement. Request medical records and vascular testing documentation for a sample of claims under procedure codes 93970 and 93971, given the 77th and 90th percentile rankings, and for procedure code 36478, which represents 54 percent of Medicaid dollars. If the review supports a credible allegation of fraud for which an investigation is pending, 42 CFR 455.23(a) requires the state agency to suspend all Medicaid payments unless good cause exists not to suspend or to suspend only in part, and 42 CFR 455.23(d) requires referral to the Medicaid Fraud Control Unit.

• The California listing is a California program action and the payments identified were made by the Arizona Medicaid program, so the reviewer must confirm whether the listing carried a reciprocal effect on the paying state before drawing any conclusion.
• The listing may have been appealed, stayed, lifted or reinstated, and the record cited is a Suspended and Ineligible Provider List dated July 2026, so effective dates and current status must be confirmed against the source agency.
• Identity matching by name and National Provider Identifier may be imperfect and the listed party may be a different individual, so identity should be verified per 42 CFR 455.436 before any action.
• Claims may have been submitted under a group or supervising arrangement, so the rendering and billing identifiers on the paid claims need to be examined before attributing payments to this individual.
• Data lag and retroactive adjustments in T-MSIS and in state paid claims extracts can shift service months and dollar totals, and the dollars at risk figure is described as the figure of the detector that set the tier rather than a sum.
• High percentile rankings on the two vein ultrasound codes may reflect a vascular practice with a concentrated case mix rather than an aberrant billing pattern, and two of the codes rank at the 28th and 36th percentile, below the typical amount.