Providers
KHEDER KUTMAH, M.D.
NPI 1487666228, individual, Florence, KY, Internal Medicine, Pulmonary Disease
5
Evidence tier
informational
score 31 of 100, rank 10878, $1.6M at stake
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | KHEDER KUTMAH, M.D. |
| Type | Individual, sole proprietor |
| Status | Active |
| NPI issued | August 12, 2006, last updated April 24, 2012 |
| Practice location | 8820 BANKERS ST, Florence, KY 41042-4212, 859-992-4660 |
| Mailing address | PO BOX 304, Florence, KY 41022-0304 |
| Specialties | Internal Medicine (207R00000X, license 35543 KY) Internal Medicine, Critical Care Medicine (207RC0200X, license 35543 KY) Internal Medicine, Pulmonary Disease (207RP1001X, primary, license 35543 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 | |
|---|---|---|---|---|---|---|---|
| 99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | $764K | 34% | $197 | $96 (top 5% from $249) | 90th percentile | |
| 99291 | Critical care, first 30-74 minutes | $273K | 12% | $357 | $175 (top 5% from $536) | 85th percentile | |
| 99222 | Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes | $247K | 11% | $57 | $63 (top 5% from $137) | 42nd percentile | |
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | $244K | 11% | $53 | $67 (top 5% from $174) | 34th percentile | |
| 95810 | Sleep study in sleep lab (6 years or older) | $189K | 9% | $224 | $250 (top 5% from $851) | 47th percentile | |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $167K | 8% | $53 | $60 (top 5% from $133) | 41st percentile | |
| 99204 | New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more | $86K | 4% | $95 | $95 (top 5% from $171) | 50th percentile | |
| G0463 | Medicaid service code | $59K | 3% | $95 | $73 (top 5% from $142) | 69th 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 |
|---|---|---|---|---|---|---|---|---|
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | 3,914 | 844 | $227K | $125 | $73 | 1.7x | 2.6x (90th percentile 4.3x) |
| 99222 | Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes | 930 | 764 | $88K | $250 | $120 | 2.1x | 2.7x (90th percentile 4.4x) |
| 99291 | Critical care, first 30-74 minutes | 272 | 71 | $43K | $375 | $198 | 1.9x | 4.7x (90th percentile 10.0x) |
| 99215 | Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more | 264 | 205 | $30K | $250 | $144 | 1.7x | 2.4x (90th percentile 4.1x) |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | 334 | 236 | $27K | $175 | $103 | 1.7x | 2.3x (90th percentile 3.8x) |
| 99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | 248 | 169 | $21K | $175 | $107 | 1.6x | 2.6x (90th percentile 4.7x) |
| 31645 | Aspiration of initial secretion of lung airway using an endoscope | 101 | 93 | $10K | $500 | $121 | 4.1x | 7.1x (90th percentile 24.1x) |
| 99205 | New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more | 38 | 38 | $5K | $300 | $168 | 1.8x | 2.6x (90th percentile 4.2x) |
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
6 providers in Boone County, KY carry an indicator in the public record, with $2.0M at stake between them. The most common is more hours than a day holds, on 3 of them, followed by part of a provider network on 2. 1 is tier 1: documented action, then payment.
| tier | provider | at stake | why |
|---|---|---|---|
| 1 | TIMOTHY EHN Florence, KY, ranked 656 | $0 |
|
| 3 | EVAN GRAY, LLC Florence, KY, ranked 5609 | $0 |
|
| 3 | BOONESPRING TRANSITIONAL CARE CENTER, LLC Union, KY, ranked 6177 | $0 |
|
| 5 | MICHAEL FLETCHER Florence, KY, ranked 10493 | $56K |
|
| 5 | NELSON TAURO Florence, KY, ranked 10982 | $1.1M | |
| 5 | BRETT BLEVINS Florence, KY, ranked 11084 | $847K |
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.