GARY J SPROUSE, M.D.

NPI 1255443727, individual, Chester, MD, Internal Medicine

Evidence tier

structure or single-organization volume

Hours beyond a day in 17 months under one organization, which can be supervisory billing.
Records needed.
Medicaid dollars per patient on code 99307 ($166 per patient-month) sit in the top 5% of every provider billing that code.

score 55 of 100, rank 7873, $816K at stake

Public list actions

Medicare revocation effective June 25, 2025, barred from re-enrolling until January 1, 2031

424.535(a)(9) failure to report and 424.535(a)(12) other program termination (medicaid), Practitioner - Internal Medicine, MD

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 2018	More hours than a day holds at a conservative unit price	2.5	59.4	39.6	53.4	66	1	99214 99309	$14K
Feb 2018	More hours than a day holds at a conservative unit price	2.3	55.3	36.9	51.6	57	1	99214 99309	$11K
Mar 2018	More hours than a day holds at a conservative unit price	2.1	49.9	33.3	46.9	57	1	99214 99309	$11K
Apr 2018	More hours than a day holds at a conservative unit price	1.9	47.1	31.4	44.8	41	1	99309	$10K
May 2018	More hours than a day holds at a conservative unit price	2.4	55.7	37.1	50.0	60	1	99214 99309	$13K
Jun 2018	More hours than a day holds at a conservative unit price	2.1	49.6	33.1	47.2	54	1	99214 99309	$11K
Aug 2018	More hours than a day holds at a conservative unit price	4.6	57.6	38.4	51.7	140	1	99214 99306 99309 99310	$14K
Sep 2018	More hours than a day holds at a conservative unit price	4.3	52.5	35.0	52.5	134	1	99214 99306 99309 99310	$13K
Oct 2018	More hours than a day holds at a conservative unit price	4.2	50.2	33.4	45.1	129	1	99214 99215 99309 99310	$13K
Nov 2018	More hours than a day holds at a conservative unit price	3.4	40.9	27.2	37.1	111	1	99215 99309 99310	$10K
Dec 2018	More hours than a day holds at a conservative unit price	3.6	38.9	25.9	38.3	103	1	99214 99309	$9K
May 2020	More hours than a day holds, even counting one unit per claim line	30.7	35.2	23.5	34.7	204	1	99307 99309	$27K
Jun 2020	More hours than a day holds, even counting one unit per claim line	35.9	40.4	26.9	36.7	238	1	99306 99307 99309 99310	$30K
Jul 2020	More hours than a day holds, even counting one unit per claim line	29.1	35.2	23.5	31.7	191	1	99306 99307 99309 99310	$27K
Aug 2020	More hours than a day holds, even counting one unit per claim line	25.8	34.4	22.9	33.8	135	1	99307 99309 99310	$26K
Sep 2020	More hours than a day holds, even counting one unit per claim line	25.9	35.8	23.8	32.5	139	1	99307 99309	$25K
Sep 2022	More hours than a day holds, even counting one unit per claim line	27.7	15.2	10.1	13.8	261	1	99306 99309 99310	$13K

National provider registry

From the CMS NPPES Registry, refreshed daily.

Name	GARY J SPROUSE, M.D.
Type	Individual, sole proprietor
Status	Active
NPI issued	August 31, 2006, last updated April 14, 2011
Practice location	2108 DIDONATO DR, Chester, MD 21619-2628, 410-643-6205
Specialties	Internal Medicine (207R00000X, primary, license D32036 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
99309	Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	$689K	76%	$94	$21 (top 5% from $84)	96th percentile
99307	Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 10 minutes	$117K	13%	$166	$7.86 (top 5% from $34)	100th percentile
99310	Subsequent nursing facility care with high level of medical decision making, per day, if using time, at least 45 minutes	$40K	4%	$57	$30 (top 5% from $134)	77th percentile
99306	Initial nursing facility care with high level of medical decision making, per day, if using time, 50 minutes or more	$32K	4%	$54	$37 (top 5% from $100)	71st percentile
99214	Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	$21K	2%	$61	$60 (top 5% from $133)	51st 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	$6K	1%	$45	$88 (top 5% from $210)	16th percentile

In this area

76 providers in MD carry an indicator in the public record, with $112.7M 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	Adjudicated (sentenced) per a state attorney general release dated September 30, 2024. Medicaid paid $14,399 in the last 12 observed months. and 4 more
1	GUIDING LIVES Baltimore, MD, ranked 57	$1.4M	Adjudicated (sentenced) per a state attorney general release dated December 8, 2025. Medicaid paid $1,358,665 in the last 12 observed months.
1	ANOTHER CHANCE SUPPORTIVE SERVICES Baltimore, MD, ranked 67	$874K	Adjudicated (sentenced) per a state attorney general release dated December 8, 2025. Medicaid paid $873,505 in the last 12 observed months.
1	QOL COMMUNICATION SERVICES, LLC Owings Mills, MD, ranked 73	$729K	Listed on the Medicare revocation list since June 12, 2024. Medicaid still paid claims in 6 later months, $728,911 in total.
1	AMSTRONG CHAPAJONG Glenarden, MD, ranked 109	$232K	Adjudicated (charged, pleaded guilty) per a Department of Justice release and an HHS-OIG enforcement record dated June 30, 2025. Medicaid paid $232,110 in the last 12 observed months.
1	LABORATORY RX, LLC Frederick, MD, ranked 131	$132K	Listed on the Medicare revocation list since November 19, 2021. Medicaid still paid claims in 8 later months, $131,826 in total.
1	ADAM MEDICAL EQUIPMENT INC Frederick, MD, ranked 168	$66K	Listed on the MI Medicaid exclusion list and the MD Medicaid exclusion list and the SC Medicaid exclusion list and the Medicare revocation list since December 13, 2023. Medicaid still paid claims in 11 later months, $66,391 in total.
1	RICHARD O AKOTO MD PA Takoma Park, MD, ranked 510	$0	Adjudicated (civil judgment) per a Department of Justice release dated August 11, 2025. No Medicaid payments in the last 12 observed months.

All 76 in MD

Recent enforcement in MD

All releases

Department 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.

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