Providers
MATTHEW GORMAN
NPI 1427130392, individual, Washington, IL, Internal Medicine
4
Evidence tier
structure or single-organization volume
- Hours beyond a day in 4 months, but with up to 2519 patients a month, which points to a supervising clinician on the claims rather than one person's hours.
- Records needed.
score 51 of 100, rank 9187, $544K 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 |
|---|---|---|---|---|---|---|---|---|---|
| May 2021 | More hours than a day holds, even counting one unit per claim line | 25.3 | 26.7 | 17.8 | 26.3 | 2147 | 1 | 99202 99203 99204 99212 99213 99214 | $101K |
| Jun 2021 | More hours than a day holds, even counting one unit per claim line | 26.4 | 28.0 | 18.7 | 25.5 | 2105 | 1 | 99202 99203 99204 99212 99213 99214 | $102K |
| Jul 2021 | More hours than a day holds, even counting one unit per claim line | 36.7 | 36.2 | 24.1 | 34.0 | 2519 | 1 | 99202 99203 99204 99212 99213 99214 | $136K |
| Jun 2023 | More hours than a day holds, even counting one unit per claim line | 29.9 | 33.7 | 22.5 | 30.7 | 2462 | 1 | 99203 99204 99212 99213 99214 99421 | $118K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | MATTHEW GORMAN |
| Type | Individual |
| Status | Active |
| NPI issued | October 20, 2006, last updated March 27, 2008 |
| Practice location | 10 SAINT CLARE CT, Washington, IL 61571-9239, 309-886-4000 |
| Specialties | Internal Medicine (207R00000X, primary, license 036-100821 IL) Pediatrics (208000000X, license 036-100821 IL) |
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 | $575K | 52% | $53 | $44 (top 5% from $110) | 62nd percentile | |
| 87426 | Detection test by immunoassay technique for severe acute respiratory syndrome coronavirus | $131K | 12% | $40 | $32 (top 5% from $49) | 76th percentile | |
| 99203 | New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more | $97K | 9% | $52 | $67 (top 5% from $121) | 26th percentile | |
| 99212 | Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more | $54K | 5% | $34 | $28 (top 5% from $147) | 62nd percentile | |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $41K | 4% | $82 | $60 (top 5% from $133) | 72nd percentile | |
| 87880 | Detection test by immunoassay with direct visual observation for streptococcus, group a (strep) | $38K | 3% | $16 | $12 (top 5% from $18) | 92nd percentile | |
| 59430 | Medicaid service code | $32K | 3% | $169 | $89 (top 5% from $215) | 86th percentile | |
| 0500F | Medicaid service code | $28K | 3% | $105 | $0.11 (top 5% from $73) | 98th 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 |
|---|---|---|---|---|---|---|---|---|
| 71046 | X-ray of chest, 2 views | 1,197 | 571 | $12K | $111 | $16 | 6.8x | 3.6x (90th percentile 8.1x) |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | 210 | 200 | $11K | $208 | $89 | 2.3x | 2.2x (90th percentile 3.8x) |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | 56 | 47 | $4K | $294 | $122 | 2.4x | 2.3x (90th percentile 3.8x) |
| 73564 | X-ray of knee, 4 or more views | 205 | 101 | $3K | $154 | $23 | 6.7x | 3.6x (90th percentile 7.5x) |
| 73630 | X-ray of foot, minimum of 3 views | 285 | 144 | $3K | $115 | $17 | 6.9x | 3.6x (90th percentile 8.1x) |
| 99203 | New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more | 41 | 41 | $3K | $285 | $115 | 2.5x | 2.4x (90th percentile 3.9x) |
| 73130 | X-ray of hand, minimum of 3 views | 207 | 105 | $2K | $124 | $18 | 6.7x | 3.9x (90th percentile 8.4x) |
| 73110 | X-ray of wrist, minimum of 3 views | 161 | 82 | $2K | $133 | $20 | 6.7x | 3.9x (90th percentile 8.8x) |
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
2 providers in Tazewell County, IL carry an indicator in the public record, with $0 at stake between them. The most common is part of a provider network, on 2 of them.
| tier | provider | at stake | why |
|---|---|---|---|
| 3 | PETERSEN HEALTH OPERATIONS, LLC East Peoria, IL, ranked 1800 | $0 |
|
| 3 | PETERSEN HEALTH OPERATIONS, LLC Pekin, IL, ranked 3646 | $0 |
|
Recent enforcement in IL
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
DOJChargedJun 23, 2026
United States Attorney Andrew S. Boutros Announces Charges Against Two Chicago-Area Defendants as Part of Department of Justice’s National Healthcare Fraud Takedown
Two Chicago-area defendants were charged, one for selling Medicare beneficiary information and providing fake AI-generated consent recordings so laboratories could bill Medicare for over-the-counter Covid-19 test kits that were never requested or provided, and the other for directing the creation of fake medical records and billing Illinois Medicaid for behavioral health counseling and therapy services that were never provided, including for deceased beneficiaries.
DOJConvictedJun 18, 2026
Suburban Chicago Chiropractor Convicted of Healthcare Fraud
A chiropractor submitted fraudulent claims to Blue Cross Blue Shield of Illinois for health care services that were not actually provided and submitted false patient medical records when the insurer attempted to audit the claims.
DOJSentencedJun 10, 2026
Jacksonville Chiropractor Sentenced to a Year in Prison for Healthcare Fraud and Related Offenses
Rondeau submitted more than 2,000 fraudulent claims to health insurance companies and convinced clients to sign false documents after learning he was under investigation.
DOJCivil settlementMay 8, 2026
Three Affiliated Skilled Nursing Facilities to Pay $300,000 to Resolve False Claims Act Allegations Related to Medically Unnecessary Rehabilitation Services
Three affiliated skilled nursing facilities billed Medicare between Jan. 1, 2014, and Sept. 30, 2019, for physical therapy, occupational therapy, and speech pathology services provided to patients for longer than medically necessary and without regard for patients' individual medical needs, resulting in claims based on inflated RUG levels.
DOJIndictedFeb 12, 2026
Two Foreign Nationals Indicted in Chicago as Part of $10 Million Health Care Fraud Scheme
The indictment alleges the defendants used nominee-owned laboratories and durable medical equipment providers to submit fraudulent claims to Medicare and private health care benefit programs for items and services that were not provided, and laundered and transferred proceeds to Pakistan.
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.