Providers
THOMAS J RALEY, MD
NPI 1518967207, individual, Stafford, VA, Orthopaedic Surgery
1
Evidence tier
documented action, then payment
- Listed on the Medicare revocation list since November 19, 2021.
- Medicaid still paid claims in 9 later months, $252,808 in total.
score 95 of 100, rank 104, $253K at stake
Public list actions
Medicare revocation effective November 19, 2021, barred from re-enrolling until November 19, 2031
424.535(a)(9) failure to report and 424.535(a)(3) felonies, Practitioner - Orthopedic Surgery, DC
Medicare revocation effective November 19, 2021, barred from re-enrolling until November 19, 2031
424.535(a)(9) failure to report and 424.535(a)(3) felonies, Practitioner - Orthopedic Surgery, VA
Medicare revocation effective November 19, 2021, barred from re-enrolling until November 19, 2031
424.535(a)(9) failure to report and 424.535(a)(3) felonies, Practitioner - Orthopedic Surgery, MD
OIG exclusion December 20, 2023 under section 1128a1
Physician (MD, DO), Orthopedics, Cumberland, MD
Paid after the action
Months in which Medicaid paid claims for this provider after a public action that should have triggered a screening check. This is a record of payments, not a determination that they were improper.
| list | identity check | action date | window closed | months paid after | first | last | paid after | 12 months before |
|---|---|---|---|---|---|---|---|---|
| Medicare revocation list 424.535(a)(9) failure to report and 424.535(a)(3) felonies | Exact NPI, name verified | Nov 19, 2021 | Nov 19, 2031 | 9 | Dec 2021 | Aug 2022 | $253K | $393K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | THOMAS J RALEY, MD |
| Type | Individual, sole proprietor |
| Status | Active |
| NPI issued | July 26, 2005, last updated October 24, 2020 |
| Practice location | 450 GARRISONVILLE RD, SUITE 109, Stafford, VA 22554, 703-522-2727 |
| Specialties | Orthopaedic Surgery (207X00000X, license MD037178 DC) Orthopaedic Surgery (207X00000X, license 0101243103 VA) Orthopaedic Surgery (207X00000X, license D0068746 MD) Orthopaedic Surgery (207X00000X, primary, license MD425955 PA) |
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 | |
|---|---|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $434K | 67% | $65 | $60 (top 5% from $133) | 56th percentile | |
| 80307 | Testing for presence of drug, by chemistry analyzers | $170K | 26% | $33 | $45 (top 5% from $110) | 36th percentile | |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | $37K | 6% | $15 | $44 (top 5% from $110) | 13th percentile | |
| 99204 | New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more | $5K | 1% | $27 | $95 (top 5% from $171) | 5th percentile | |
| J1100 | Injection, dexamethasone sodium phosphate, 1 mg | $163 | 0% | $1.94 | $0.62 (top 5% from $14) | 78th percentile | |
| J3301 | Injection, triamcinolone acetonide, not otherwise specified, 10 mg | $61 | 0% | $0.49 | $3.46 (top 5% from $11) | 11th percentile | |
| 99072 | Medicaid service code | $0 | 0% | $0.00 | $0.00 (top 5% from $11) | too few months to rank | |
| 1006F | Medicaid service code | $0 | 0% | $0.00 | $0.00 (top 5% from $0.54) | too few months to rank |
In this area
3 providers in Stafford County, VA carry an indicator in the public record, with $7.2M at stake between them. The most common is more hours than a day holds, on 2 of them, followed by paid after a public list action on 1. 1 is tier 1: documented action, then payment.
| tier | provider | at stake | why |
|---|---|---|---|
| 1 | ADVANCED SPINE AND PAIN CENTERS, PLLC Stafford, VA, ranked 58 | $1.3M |
|
| 4 | NATHER ANSARI Stafford, VA, ranked 8379 | $5.7M |
|
| 5 | PETROS AYELE Stafford, VA, ranked 11536 | $151K |
Recent enforcement in VA
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
DOJChargedJun 23, 2026
U.S. Attorney’s Office announces charges against three defendants in the Eastern District of Virginia as part of national health care fraud takedown
Three defendants were charged with fraudulently billing Medicaid for mental health services that were not provided and with submitting false claims to Medicare through a straw-owned durable medical equipment company.
DOJSentencedJun 5, 2026
Medicaid service providers sentenced for false statements resulting in overbilling
Wright and Winfield instructed CCR employees to falsely claim in progress notes that children received therapeutic day treatment services from 2:00pm to 7:00pm, including providing prefilled progress note templates, resulting in overbilling to Medicaid.
DOJCivil settlementApr 27, 2026
Tri-Area Community Health Agrees to Pay $513,000 to Resolve Medicare Billing Allegations
Tri-Area Community Health billed Medicare for Annual Wellness Visits provided by pharmacists without appropriate physician supervision that were billed under the names of physicians not involved with the visits.
DOJSentencedMar 17, 2026
Six Sentenced in Healthcare Fraud Conspiracy that Stole $10 Million from Medicaid Over Six-Year Period
Six defendants conspired to submit false claims to Virginia Medicaid on behalf of 1st Adult N Pediatric Healthcare Services for nursing and personal care services that were not provided, including falsifying records and paying parents or guardians of patients for blank, signed nursing notes.
DOJIndictedMar 11, 2026
Victim Advisory- Divine Youth Case Updates
Divine Youth Counseling submitted more than $11 million in fraudulent Medicaid claims for Crisis Stabilization and Mobile Crisis services by falsely claiming two mental health professionals provided Team Treatment services and paid more than $470,000 in kickbacks in the form of hotel rooms for Medicaid recipients.
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.