JAMES DAVID ABEL, MD

NPI 1376729244, individual, Fairmont, WV, Psychiatry & Neurology, Psychiatry

Evidence tier

informational

Medicaid dollars per patient on code 99232 ($240 per patient-month) sit in the top 5% of every provider billing that code.

score 34 of 100, rank 10378, $222K at stake

National provider registry

From the CMS NPPES Registry, refreshed daily.

Name	JAMES DAVID ABEL, MD
Type	Individual
Status	Active
NPI issued	January 10, 2008, last updated August 14, 2013
Practice location	1228 COUNTRY CLUB RD, SUITE 800, Fairmont, WV 26554-2369, 304-367-7100
Specialties	Psychiatry & Neurology, Psychiatry (2084P0800X, primary, license 23940 WV)

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
99232	Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	$284K	47%	$240	$67 (top 5% from $174)	98th percentile
90792	Psychiatric diagnostic evaluation with medical services	$123K	20%	$115	$112 (top 5% from $313)	52nd percentile
99214	Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	$89K	15%	$80	$60 (top 5% from $133)	70th percentile
99213	Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more	$55K	9%	$56	$44 (top 5% from $110)	66th percentile
99238	Hospital discharge day management, 30 minutes or less	$40K	7%	$55	$48 (top 5% from $80)	63rd percentile
80305	Testing for presence of drug, read by direct observation	$8K	1%	$45	$9.23 (top 5% from $22)	99th percentile
90834	Psychotherapy, 45 minutes	$5K	1%	$76	$101 (top 5% from $318)	too few months to rank
99222	Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	$3K	1%	$109	$63 (top 5% from $137)	too few months to rank

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
99213	Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more	148	54	$6K	$330	$59	5.6x	2.2x (90th percentile 3.8x)

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

47 providers in WV carry an indicator in the public record, with $22.4M at stake between them. The most common is more hours than a day holds, on 33 of them, followed by part of a provider network on 6. 6 are tier 1: documented action, then payment.

tier	provider	at stake	why
1	JOSEPH JURAND Martinsburg, WV, ranked 194	$48K	Listed on the MD Medicaid exclusion list since September 11, 2015. Medicaid still paid claims in 8 later months, $47,640 in total.
1	MICHAEL SHRAMOWIAT LLC Vienna, WV, ranked 202	$43K	Listed on the Medicare revocation list since November 19, 2014. Medicaid still paid claims in 21 later months, $42,976 in total.
1	SHAWN BLANKENSHIP Charleston, WV, ranked 289	$0	Adjudicated (pleaded guilty) per a state attorney general release dated March 20, 2025. No Medicaid payments in the last 12 observed months. and 4 more
1	HUGH SMITH Charleston, WV, ranked 314	$6K	Listed on the Medicare revocation list since January 7, 2021. Medicaid still paid claims in 5 later months, $6,083 in total.
1	WILLIAM EARLEY Vienna, WV, ranked 428	$265	Listed on the SC Medicaid exclusion list since May 1, 2018. Medicaid still paid claims in 1 later month, $265 in total.
1	HOLISTIC, INC Charleston, WV, ranked 557	$0	Adjudicated (pleaded guilty) per a state attorney general release dated March 20, 2025. No Medicaid payments in the last 12 observed months.
3	BRIAN MCDEVITT Chapmanville, WV, ranked 1665	$915	Charged (indicted) per a Department of Justice release dated June 27, 2024, not adjudicated. Medicaid paid $915 in the last 12 observed months.
3	HARRELL NURSING HOME Charleston, WV, ranked 2693	$0	Part of provider network D1-00115, ranked 115 nationally.

All 47 in WV

Recent enforcement in WV

All releases

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

DOJCivil settlementJun 23, 2026

Northern District of West Virginia Part of National Health Care Fraud Takedown Resulting in 455 Defendants Charged in Connection with Over $6.5 Billion in Alleged Fraud

Two providers reached civil settlements resolving allegations that they used pre-signed, invalid prescriptions issued outside the usual course of their professional practice to patients in West Virginia while traveling and not in close proximity to their offices, and in one case submitted claims to Medicare and Medicaid during that time.

DOJComplaint filedJun 23, 2026

U.S. Attorney Moore Capito Announces Fraud Conspiracy Charges Against Sober Living Home Founder and Spouse

Two individuals affiliated with a sober living recovery program allegedly conspired to falsify and submit timesheets to a testing laboratory for drug testing work not performed, and the laboratory paid the billings and obtained reimbursement from federal and state healthcare programs; separately, a sleep laboratory paid $120,000 to resolve allegations it billed Medicaid and the VA Community Health program for sleep studies and polysomnogram reports prepared and signed by unqualified, non-physician staff.

DOJPleaded guiltyJun 17, 2026

Mercer County Woman Pleads Guilty to $175,731.31 Fraud Scheme Targeting Federal Veterans Health Care Benefits

Radford, an owner of Healthcare Therapy Services LLC doing business as Medical Massage Therapy, submitted false bills to CHAMPVA for massage services not rendered, stealing $175,731.31.

DOJCivil settlementMar 5, 2026

Laboratory Agrees to Pay More than $200,000 for Improper Billing to West Virginia Medicaid Program

Integra repeatedly submitted billings to the West Virginia Medicaid program for medically unnecessary testing ordered by medical providers over a two-year period, specifically improper claims for specimen validity testing that were not allowable.

DOJCivil settlementApr 2, 2025

Beckley Medical Clinic and Physician Agree to Pay $152,382.70 to Resolve False Claims Act Allegations

Med-Surg and its owner submitted claims to Medicare and Medicaid using HCPCS code Q3014 for the telehealth originating site facility fee for telehealth visits where the patient was at home, which is not payable.

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.