VERNON CHARLTON WHITLEY, MD

NPI 1295818987, individual, Barnwell, SC, Pediatrics

Evidence tier

structure or single-organization volume

Hours beyond a day in 3 months, but with up to 1064 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 99213 ($160 per patient-month) sit in the top 5% of every provider billing that code.

score 55 of 100, rank 7889, $733K 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 2018	More hours than a day holds at a conservative unit price	13.1	46.3	30.8	41.6	1064	2	99212 99213 99214 99238	$183K
Feb 2018	More hours than a day holds at a conservative unit price	12.9	45.9	30.6	42.8	932	2	99212 99213 99214	$164K
Mar 2018	More hours than a day holds at a conservative unit price	11.2	39.8	26.6	37.4	895	2	99212 99213 99214 99215	$157K

National provider registry

From the CMS NPPES Registry, refreshed daily.

Name	VERNON CHARLTON WHITLEY, MD
Type	Individual
Status	Active
NPI issued	October 24, 2006, last updated January 11, 2024
Practice location	10706 MARLBORO AVE, Barnwell, SC 29812-6376, 803-259-7337
Mailing address	86 WREN ST, Barnwell, SC 29812-1529
Specialties	Pediatrics (208000000X, primary, license 18498 SC)

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
99213	Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more	$1.5M	65%	$160	$44 (top 5% from $110)	98th percentile
99391	Medicaid service code	$187K	8%	$151	$76 (top 5% from $126)	97th percentile
99392	Medicaid service code	$177K	8%	$141	$78 (top 5% from $124)	97th percentile
99214	Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	$108K	5%	$154	$60 (top 5% from $133)	97th percentile
90460	Administration of first vaccine or toxoid component with counseling (18 years or younger)	$75K	3%	$36	$26 (top 5% from $54)	70th percentile
99393	Medicaid service code	$66K	3%	$154	$78 (top 5% from $121)	98th percentile
99394	Medicaid service code	$65K	3%	$150	$83 (top 5% from $128)	97th percentile
99212	Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	$54K	2%	$137	$28 (top 5% from $147)	94th percentile

In this area

79 providers in SC carry an indicator in the public record, with $45.4M at stake between them. The most common is part of a provider network, on 39 of them, followed by more hours than a day holds on 31. 4 are tier 1: documented action, then payment.

tier	provider	at stake	why
1	TRANSFORMATION SERVICES Lancaster, SC, ranked 203	$41K	Adjudicated (sentenced, pleaded guilty) per a Department of Justice release dated April 2, 2025. Medicaid paid $41,463 in the last 12 observed months.
1	ACHIEVE BEHAVIORAL HEALTH PA Greenville, SC, ranked 224	$27K	Listed on the Medicare revocation list and the SC Medicaid exclusion list since May 24, 2023. Medicaid still paid claims in 17 later months, $26,595 in total.
1	KEVIN PATEL Charleston, SC, ranked 226	$26K	Listed on the Medicare revocation list since February 18, 2021. Medicaid still paid claims in 8 later months, $25,913 in total.
1	PREMIER MEDICAL, INC. Greenville, SC, ranked 499	$0	Adjudicated (civil judgment) per a Department of Justice release dated July 17, 2025. No Medicaid payments in the last 12 observed months.
2	RYEDENNA SIMON - MCQUEEN Florence, SC, ranked 708	$239K	Billed more hands-on hours than a day holds in 1 month, peaking at 17.8 hours per day across 3 billing organizations. Medicaid dollars per patient on code 90837 ($451 per patient-month) sit in the top 5% of every provider billing that code.
2	KENNETH MARTIN Columbia, SC, ranked 725	$1.9M	Billed more hands-on hours than a day holds in 6 months, peaking at 18.3 hours per day across 3 billing organizations.
3	ROPER ST FRANCIS ANCILLARY SERVICES Ladson, SC, ranked 804	$328K	Part of provider network D1-00115, ranked 115 nationally. Medicaid dollars per patient on code A9900 ($504 per patient-month) sit in the top 5% of every provider billing that code.
3	INSPIRIUM IHC UPSTATE, LLC Greenville, SC, ranked 1077	$794K	Part of provider network D1-00040, ranked 40 nationally.

All 79 in SC

Recent enforcement in SC

All releases

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

DOJIndictedMar 11, 2026

Former Greenville CEO, Employees Indicted in Multi-Million Dollar Health Care Fraud Scheme

The defendants submitted false claims to health care benefit programs for individual COVID-19 tests that had actually been pooled for combined processing and manipulated test processing software, billing for tests that were virtually worthless and ineligible for reimbursement.

DOJSentencedFeb 25, 2026

Lancaster Trio Sentenced for Health Care Fraud Conspiracy

An excluded Medicaid provider and his wife established Transformation Services in her name to bill Medicaid for behavioral health services that were overlapping, not rendered individually, and provided by unlicensed therapists, defrauding Medicaid of nearly $250,000.

DOJIndictedNov 18, 2025

Florida Man Indicted for Health Care Fraud, Wire Fraud in Durable Medical Equipment Scheme

Weinberger, who was excluded from Medicare, allegedly concealed his ownership and control of a Medicare-enrolled durable medical equipment company through a false enrollment document and, with coconspirators, used call centers to generate doctors' orders for orthotic braces and submit approximately $6.7 million in false and fraudulent claims obtained through kickbacks and bribes, medically unnecessary, or otherwise ineligible for reimbursement.

DOJCivil judgmentJul 17, 2025

United States and the States of Georgia, Colorado, and South Carolina Obtain $114.5M in Judgments in a Sprawling Cancer Genetic Testing Lab Scheme

Premier Medical, its owner and compliance vice president paid kickbacks to Freedom Medical Labs and its marketers, who collected DNA samples from Medicaid beneficiaries in public spaces and purchased telemedicine physician orders, to bill Medicaid for medically unnecessary cancer genetic testing.

DOJIndictedJun 30, 2025

S.C. Cases Among Hundreds Announced in National Health Care Fraud Takedown

Two defendants were charged with submitting false claims to Medicare and Medicaid for durable medical equipment that was not delivered or authorized, and with billing the Veterans Administration for massage therapy services not rendered.

Referral packet

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