Providers
All 22 in KY
THOMAS WILLIAM HOWARD, III, M.D.
NPI 1457580003, individual, Lexington, KY, Internal Medicine, Rheumatology
4
Evidence tier
structure or single-organization volume
- Hours beyond a day in 32 months, but with up to 2083 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 8540, $3.1M 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, even counting one unit per claim line | 48.6 | 39.5 | 26.3 | 35.5 | 1202 | 1 | 90832 90834 90837 90853 99213 99214 | $86K |
| Feb 2018 | More hours than a day holds, even counting one unit per claim line | 121.7 | 38.6 | 25.7 | 36.0 | 1215 | 1 | 90832 90834 90837 90853 99213 99214 | $76K |
| Mar 2018 | More hours than a day holds, even counting one unit per claim line | 65.3 | 33.5 | 22.3 | 31.4 | 1266 | 1 | 90832 90837 90853 99213 99214 | $75K |
| Apr 2018 | More hours than a day holds, even counting one unit per claim line | 39.4 | 30.9 | 20.6 | 29.4 | 1319 | 1 | 90832 90834 90837 90853 99204 99213 99214 | $67K |
| May 2018 | More hours than a day holds, even counting one unit per claim line | 68.4 | 29.6 | 19.7 | 26.6 | 1320 | 1 | 90834 90837 90853 99213 | $66K |
| Jun 2018 | More hours than a day holds, even counting one unit per claim line | 65.7 | 35.3 | 23.5 | 33.6 | 1474 | 1 | 90832 90834 90837 90853 99213 | $76K |
| Jul 2018 | More hours than a day holds, even counting one unit per claim line | 59.6 | 37.4 | 25.0 | 35.2 | 1545 | 1 | 90832 90834 90837 90853 99204 99213 | $83K |
| Aug 2018 | More hours than a day holds, even counting one unit per claim line | 31.9 | 31.8 | 21.2 | 28.6 | 1353 | 1 | 90834 90837 90853 99213 | $71K |
| Sep 2018 | More hours than a day holds, even counting one unit per claim line | 51.5 | 36.1 | 24.1 | 35.8 | 1403 | 1 | 90832 90834 90837 90853 99204 99213 H0038 | $79K |
| Oct 2018 | More hours than a day holds, even counting one unit per claim line | 50.3 | 40.3 | 26.9 | 34.1 | 1555 | 1 | 90832 90834 90837 90853 99204 99213 H0038 | $89K |
| Nov 2018 | More hours than a day holds, even counting one unit per claim line | 40.0 | 40.8 | 27.2 | 31.6 | 1581 | 1 | 90832 90834 90837 90853 99213 H0038 | $84K |
| Dec 2018 | More hours than a day holds, even counting one unit per claim line | 32.5 | 36.3 | 24.2 | 31.3 | 1503 | 1 | 90832 90833 90834 90837 90853 99213 H0038 | $78K |
| Jan 2019 | More hours than a day holds, even counting one unit per claim line | 43.1 | 54.0 | 36.0 | 44.3 | 1786 | 1 | 90832 90833 90834 90837 90838 90853 99204 99213 H0038 | $105K |
| Feb 2019 | More hours than a day holds, even counting one unit per claim line | 51.4 | 60.0 | 40.0 | 47.5 | 1853 | 1 | 90832 90833 90834 90836 90837 90838 90853 99204 99213 H0038 | $104K |
| Mar 2019 | More hours than a day holds, even counting one unit per claim line | 48.1 | 53.8 | 35.9 | 43.5 | 1906 | 1 | 90832 90833 90834 90837 90838 90853 99213 H0038 | $101K |
| Apr 2019 | More hours than a day holds, even counting one unit per claim line | 45.2 | 52.1 | 34.8 | 40.7 | 1779 | 1 | 90832 90834 90836 90837 90838 90853 99204 99213 H0038 | $98K |
| May 2019 | More hours than a day holds, even counting one unit per claim line | 52.8 | 55.2 | 36.8 | 43.3 | 1889 | 1 | 90832 90833 90834 90836 90837 90838 90853 99204 99213 H0038 | $107K |
| Jun 2019 | More hours than a day holds, even counting one unit per claim line | 50.1 | 47.9 | 31.9 | 44.8 | 1754 | 1 | 90832 90834 90837 90838 90853 99213 H0038 | $97K |
| Jul 2019 | More hours than a day holds, even counting one unit per claim line | 55.3 | 43.9 | 29.2 | 37.6 | 1632 | 1 | 90832 90834 90837 90838 90853 99213 H0038 | $94K |
| Aug 2019 | More hours than a day holds, even counting one unit per claim line | 74.4 | 47.6 | 31.8 | 42.2 | 1627 | 1 | 90832 90834 90837 90838 90853 99204 99213 H0038 | $98K |
| Sep 2019 | More hours than a day holds, even counting one unit per claim line | 139.1 | 47.4 | 31.6 | 40.6 | 1633 | 1 | 90832 90834 90837 90838 90853 99213 H0038 | $91K |
| Oct 2019 | More hours than a day holds, even counting one unit per claim line | 102.0 | 48.0 | 32.0 | 37.5 | 1585 | 1 | 90832 90834 90837 90838 90853 99213 H0038 | $95K |
| Nov 2019 | More hours than a day holds, even counting one unit per claim line | 68.7 | 45.2 | 30.1 | 38.1 | 1624 | 1 | 90832 90834 90837 90838 90853 99213 H0038 | $92K |
| Dec 2019 | More hours than a day holds, even counting one unit per claim line | 48.7 | 36.4 | 24.2 | 31.7 | 1509 | 1 | 90832 90834 90837 90853 99213 H0038 | $79K |
| Jan 2020 | More hours than a day holds, even counting one unit per claim line | 36.1 | 35.9 | 24.0 | 30.4 | 1593 | 2 | 90832 90834 90837 90853 99213 H0038 | $80K |
| Feb 2020 | More hours than a day holds, even counting one unit per claim line | 32.5 | 36.2 | 24.2 | 31.9 | 1560 | 2 | 90832 90834 90837 90853 99213 H0038 | $74K |
| Sep 2020 | More hours than a day holds, even counting one unit per claim line | 35.6 | 56.1 | 37.4 | 26.6 | 1947 | 2 | 90832 90834 90837 90853 99204 99213 H0038 | $98K |
| Oct 2020 | More hours than a day holds, even counting one unit per claim line | 40.4 | 57.0 | 38.0 | 30.9 | 2083 | 1 | 90832 90834 90837 90853 99204 99213 H0038 | $107K |
| Nov 2020 | More hours than a day holds, even counting one unit per claim line | 38.9 | 48.3 | 32.2 | 32.5 | 1853 | 1 | 90832 90834 90837 90853 99213 H0038 | $94K |
| Dec 2020 | More hours than a day holds, even counting one unit per claim line | 51.4 | 47.5 | 31.7 | 24.9 | 2021 | 1 | 90832 90834 90837 90853 99213 H0038 | $90K |
| Jan 2021 | More hours than a day holds, even counting one unit per claim line | 38.2 | 41.6 | 27.7 | 22.5 | 1802 | 1 | 90832 90834 90837 90853 99213 H0038 | $74K |
| Feb 2021 | More hours than a day holds, even counting one unit per claim line | 37.0 | 40.2 | 26.8 | 20.6 | 1610 | 1 | 90832 90834 90837 90853 99213 H0038 | $64K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | THOMAS WILLIAM HOWARD, III, M.D. |
| Type | Individual, sole proprietor |
| Status | Active |
| NPI issued | July 3, 2009, last updated March 17, 2018 |
| Practice location | 135 E MAXWELL ST STE 401, Lexington, KY 40508-2617, 859-323-3900 |
| Specialties | Internal Medicine, Addiction Medicine (207RA0401X, license 44608 KY) Internal Medicine, Rheumatology (207RR0500X, primary, license 44608 KY) |
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 | |
|---|---|---|---|---|---|---|---|
| 80307 | Testing for presence of drug, by chemistry analyzers | $1.7M | 25% | $96 | $45 (top 5% from $110) | 93rd percentile | |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | $1.5M | 22% | $82 | $44 (top 5% from $110) | 89th percentile | |
| 90837 | Psychotherapy, 1 hourhistory of abuse | $1.1M | 16% | $91 | $191 (top 5% from $442) | 12th percentile | |
| G0480 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms | $845K | 12% | $109 | $58 (top 5% from $129) | 88th percentile | |
| 90853 | Group psychotherapyhistory of abuse | $759K | 11% | $31 | $60 (top 5% from $332) | 25th percentile | |
| H0038 | Self-help/peer services per 15 min | $284K | 4% | $35 | $147 (top 5% from $2K) | 23rd percentile | |
| T2023 | Medicaid service code | $181K | 3% | $332 | $332 (top 5% from $1K) | 50th percentile | |
| 90838 | Psychotherapy with evaluation and management visit, 1 hour | $176K | 3% | $76 | $87 (top 5% from $222) | 38th percentile |
In this area
22 providers in Fayette County, KY carry an indicator in the public record, with $27.5M at stake between them. The most common is more hours than a day holds, on 18 of them, followed by named in an enforcement record on 3. 3 are tier 1: documented action, then payment.
| tier | provider | at stake | why |
|---|---|---|---|
| 1 | SERENITY KEEPERS Lexington, KY, ranked 560 | $0 |
|
| 1 | LABTOX, LLC Lexington, KY, ranked 632 | $0 |
|
| 1 | AMR MOHAMED Lexington, KY, ranked 654 | $0 |
|
| 3 | BAPTIST HEALTH HOME CARE KY LLC Lexington, KY, ranked 2798 | $0 |
|
| 4 | KATHERINE JONES Lexington, KY, ranked 8164 | $1.2M |
|
| 4 | ABDOLREZA RABIEE Lexington, KY, ranked 8284 | $11.7M |
|
| 4 | ANTHONY FLYNN Lexington, KY, ranked 8920 | $1.2M |
|
| 4 | TONI WEBB Lexington, KY, ranked 9019 | $904K |
|
Recent enforcement in KY
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
DOJIndictedAug 27, 2026
Kentucky Medical Biller Indicted for Healthcare Fraud and Money Laundering Charges
Sanders recruited individuals to open behavioral health entities, handled their Kentucky Medicaid credentialing and enrollment, and directed submission of fraudulent Medicaid claims across ten behavioral health providers for services never provided, including for incarcerated, hospitalized, or deceased members, using licensed professionals' NPIs without authorization.
DOJChargedJun 23, 2026
5 Individuals and 2 Companies Charged as Part of Department of Justice National Health Care Fraud Takedown
Seven defendants were charged in four cases with schemes including billing Kentucky Medicaid for peer support and psychoeducation services that were fraudulent, unauthorized, or not rendered using providers' NPIs, using a DEA number to order controlled substances in others' names, credentialing a company with Medicare and billing for services not rendered using a doctor's NPI, and stealing controlled substances from hospitals and falsely documenting administration.
DOJCivil settlementJun 23, 2026
Civil Settlements Reached as Part of Department of Justice National Health Care Fraud Takedown
Three Home and Community Based Waiver providers and their owners, who had shared financial interests, referred Medicaid waiver beneficiaries for attendant care services and billed Medicaid for attendant care hours that were not fully provided or not provided at all.
DOJCivil judgmentMay 15, 2026
Operators of Day Treatment Program for Children Agree to $15.2 Million Civil Judgment to Resolve Medicaid Fraud Allegations
The Government alleged that from August 2022 through June 2025 the Recovery Centers sought Medicaid payments for time children spent on education, recreation, and lunch breaks at the Aspire Day Program and that Recovery Center of Kentucky falsely represented clinician qualifications to obtain higher reimbursements.
DOJSentencedApr 24, 2026
Former Sober Home Owner and Operator Sentenced for Kickback Conspiracy and Health Care Fraud
Jordan solicited and received kickbacks in exchange for referring urine drug testing from her sober home company to three labs, and Serenity Keepers billed Medicaid for peer support services not provided by licensed peer support specialists, with Williams reporting that residents received six hours of peer support services per day knowing that was not true.
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.