PANCHAJANYA PAUL, MD

NPI 1356664007, individual, Atlanta, GA, Psychiatry & Neurology, Psychiatry

Evidence tier

structure or single-organization volume

Hours beyond a day in 1 month under one organization, which can be supervisory billing.
Records needed.
Medicaid dollars per patient on code 99233 ($338 per patient-month) sit in the top 5% of every provider billing that code.

score 55 of 100, rank 7929, $532K 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
Apr 2024	More hours than a day holds, even counting one unit per claim line	26.5	30.1	20.0	27.3	372	1	90792 90833 99213 99214 99232 99233 99239	$88K

National provider registry

From the CMS NPPES Registry, refreshed daily.

Name	PANCHAJANYA PAUL, MD
Type	Individual
Status	Active
NPI issued	March 9, 2010, last updated March 10, 2025
Practice location	6667 VERNON WOODS DR STE B20, Atlanta, GA 30328-3216, 678-250-8883
Mailing address	3070 WINDWARD PLZ # F345, Alpharetta, GA 30005-8771
Specialties	Psychiatry & Neurology, Psychiatry (2084P0800X, primary, license 069419 GA)

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
99233	Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	$828K	43%	$338	$96 (top 5% from $249)	98th percentile
99232	Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	$363K	19%	$142	$67 (top 5% from $174)	91st percentile
90833	Psychotherapy with evaluation and management visit, 30 minutes	$255K	13%	$76	$49 (top 5% from $109)	83rd percentile
99239	Hospital discharge day management, more than 30 minutes	$161K	8%	$78	$49 (top 5% from $101)	84th percentile
99223	Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	$131K	7%	$125	$81 (top 5% from $170)	83rd percentile
90792	Psychiatric diagnostic evaluation with medical services	$61K	3%	$124	$112 (top 5% from $313)	57th percentile
99213	Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more	$56K	3%	$62	$44 (top 5% from $110)	74th percentile
99214	Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	$54K	3%	$83	$60 (top 5% from $133)	73rd percentile

Medicare Part B 2024, largest codes

code	what it is	services	beneficiaries	paid	submitted per service	allowed per service	charge to allowed	usual for this code
99233	Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	132	21	$12K	$212	$116	1.8x	2.6x (90th percentile 4.7x)
90833	Psychotherapy with evaluation and management visit, 30 minutes	157	45	$8K	$145	$67	2.2x	2.1x (90th percentile 3.5x)
99214	Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	78	23	$7K	$221	$121	1.8x	2.3x (90th percentile 3.8x)
99232	Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	88	20	$5K	$147	$77	1.9x	2.6x (90th percentile 4.3x)
99213	Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more	54	17	$4K	$152	$88	1.7x	2.2x (90th percentile 3.8x)
99223	Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	15	14	$2K	$412	$168	2.4x	3.0x (90th percentile 5.6x)
99239	Hospital discharge day management, more than 30 minutes	21	21	$2K	$218	$111	2.0x	2.8x (90th percentile 5.6x)
99204	New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	14	14	$2K	$334	$162	2.1x	2.4x (90th percentile 3.9x)

A submitted charge many times the allowed amount is common and lawful; it matters when it is far above what other providers submit for the same code.

In this area

11 providers in Fulton County, GA carry an indicator in the public record, with $14.8M at stake between them. The most common is more hours than a day holds, on 4 of them, followed by paid after a public list action on 3. 3 are tier 1: documented action, then payment.

tier	provider	at stake	why
1	RAJASHAKHER REDDY Alpharetta, GA, ranked 151	$96K	Listed on the NY Medicaid exclusion list since September 6, 2011. Medicaid still paid claims in 31 later months, $95,663 in total.
1	JEFFREY GALLUPS Alpharetta, GA, ranked 172	$61K	Listed on the Medicare revocation list since October 21, 2021. Medicaid still paid claims in 3 later months, $61,386 in total. and 1 more
1	ANAND LALAJI Atlanta, GA, ranked 245	$19K	Listed on a Department of Justice release and the KY Medicaid exclusion list since November 16, 2023. Medicaid still paid claims in 12 later months, $19,383 in total.
2	SIGRID ELSTON Atlanta, GA, ranked 686	$14.1M	Billed more hands-on hours than a day holds in 9 months, peaking at 31.4 hours per day across 3 billing organizations. Medicaid dollars per patient on code 97153 ($11668 per patient-month) sit in the top 5% of every provider billing that code. and 1 more
3	CREATIVE HOSPICE CARE INC Roswell, GA, ranked 2511	$0	Part of provider network D1-00051, ranked 51 nationally.
3	AFFINITY CARE OF GEORGIA LLC Atlanta, GA, ranked 3336	$0	Part of provider network D1-00113, ranked 113 nationally.
3	RUTLEDGE MEDICAL ASSOCIATES LLC East Point, GA, ranked 5925	$0	Charged (charged) per a Department of Justice release dated June 24, 2026, not adjudicated.
3	ENNOBLE HOSPICE GA LLC Sandy Springs, GA, ranked 7024	$0	Part of provider network D1-00103, ranked 103 nationally.

All 11 in GA

Recent enforcement in GA

All releases

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

DOJIndictedAug 24, 2026

Southern District of Georgia federal indictments include murder, drug- and firearm-related charges and healthcare fraud

Perry Patalano was indicted for Healthcare Fraud, Theft of Government Money, Property or Records, and Aggravated Identity Theft.

DOJChargedJun 24, 2026

Two Georgia Men Charged in National Health Care Fraud Takedown

Rutledge billed Georgia Medicaid for thousands of wound care, cyst removal, psychotherapy, and allergy testing services that were never performed, and Releford obtained nursing jobs by lying about his qualifications and stealing a licensed practical nurse's identity, causing providers to bill Medicare and Medicaid for services he could not legally perform.

DOJSentencedMay 4, 2026

Two Sentenced to Prison for $522M Genetic Testing Fraud and Illegal Kickback Scheme Targeting Medicare and Medicaid

Two men who controlled four laboratories paid kickbacks and bribes to marketers to obtain DNA samples and fraudulent requisition forms from medical providers, resulting in approximately $522 million in false claims for medically unnecessary genetic tests.

DOJPleaded guiltyApr 14, 2026

Behavioral therapist pleads guilty to health care fraud for submitting inflated insurance reimbursement claims

From June 2020 through May 2023, Stallings submitted false and fraudulent billing claims to TRICARE for individual and group therapy services that were not provided or were not provided as presented, and also obtained COVID-19 Economic Injury Disaster Loan funds that she spent on personal purposes.

DOJSentencedDec 2, 2025

Georgia Man Sentenced for $24M Kickback and Medicare Fraud Conspiracy

Moore instructed a network of recruiters to induce Medicare beneficiaries to accept medically unnecessary genetic tests, received approximately $4.3 million in kickbacks for referring beneficiary information, DNA specimens and doctors' orders, and concealed the payments with sham invoices.

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.

Ask this case

Answers come only from the evidence tables, and every sentence cites the record it used.