JAMES KANE
NPI 1255457420, individual, West Chester, PA, Physical Therapist
- Hours beyond a day in 5 months, but with up to 21 patients a month, which points to a supervising clinician on the claims rather than one person's hours.
- Records needed.
- Medicaid dollars per patient on code 97110 ($349 per patient-month) sit in the top 5% of every provider billing that code.
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 | 0.4 | 45.9 | 30.6 | 41.2 | 21 | 1 | 97110 | $7K |
| Feb 2018 | More hours than a day holds at a conservative unit price | 0.4 | 38.4 | 25.6 | 35.8 | 17 | 1 | 97110 | $5K |
| Mar 2018 | More hours than a day holds at a conservative unit price | 0.4 | 43.3 | 28.9 | 40.7 | 19 | 1 | 97110 | $6K |
| Apr 2018 | More hours than a day holds at a conservative unit price | 0.4 | 40.7 | 27.1 | 38.8 | 20 | 1 | 97110 | $6K |
| May 2018 | More hours than a day holds at a conservative unit price | 0.5 | 48.5 | 32.3 | 43.6 | 19 | 1 | 97110 | $7K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | JAMES KANE |
| Type | Individual |
| Status | Active |
| NPI issued | March 21, 2007, last updated July 8, 2007 |
| Practice location | 638 BRANDYWINE PKWY, West Chester, PA 19380-4278, 610-436-3600 |
| Specialties | Physical Therapist (225100000X, primary, license PT011168L PA) |
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.
| code | what it is | paid | share | per patient-month | typical | rank among providers | |
|---|---|---|---|---|---|---|---|
| 97110 | Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes | $105K | 100% | $349 | $76 (top 5% from $314) | 96th percentile |
In this area
2 providers in Chester County, PA carry an indicator in the public record, with $70K at stake between them. The most common is part of a provider network, on 1 of them, followed by more hours than a day holds on 1.
| tier | provider | at stake | why |
|---|---|---|---|
| 3 | BARCLAY FRIENDS West Chester, PA, ranked 5123 | $0 |
|
| 4 | ROSALIA DUNCKLEY Chester Springs, PA, ranked 8076 | $70K |
|
Recent enforcement in PA
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
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.