SABRI SHEIKHA
NPI 1598824351, individual, Rockwall, TX, 2084P0800X
- Hours beyond a day in 2 months under one organization, which can be supervisory billing.
- Records needed.
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 2019 | More hours than a day holds at a conservative unit price | 3.2 | 45.2 | 30.2 | 40.7 | 180 | 1 | 99214 99309 99310 | $12K |
| Oct 2019 | More hours than a day holds at a conservative unit price | 5.3 | 36.8 | 24.5 | 33.1 | 221 | 1 | 99214 99309 99310 | $6K |
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.
| 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 | $158K | 32% | $38 | $60 (top 5% from $133) | 22nd percentile | |
| 99309 | Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes | $113K | 23% | $22 | $21 (top 5% from $84) | 53rd percentile | |
| 99310 | Subsequent nursing facility care with high level of medical decision making, per day, if using time, at least 45 minutes | $59K | 12% | $33 | $30 (top 5% from $134) | 53rd percentile | |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | $47K | 10% | $32 | $44 (top 5% from $110) | 30th percentile | |
| 99307 | Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 10 minutes | $39K | 8% | $11 | $7.86 (top 5% from $34) | 65th percentile | |
| 99308 | Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more | $29K | 6% | $17 | $14 (top 5% from $58) | 58th percentile | |
| 90792 | Psychiatric diagnostic evaluation with medical services | $21K | 4% | $124 | $112 (top 5% from $313) | too few months to rank | |
| 99306 | Initial nursing facility care with high level of medical decision making, per day, if using time, 50 minutes or more | $5K | 1% | $43 | $37 (top 5% from $100) | 60th percentile |
| code | what it is | services | beneficiaries | paid | submitted per service | allowed per service | charge to allowed | usual for this code |
|---|---|---|---|---|---|---|---|---|
| 99308 | Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more | 1,480 | 449 | $82K | $185 | $71 | 2.6x | 2.0x (90th percentile 3.4x) |
| 99307 | Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 10 minutes | 1,902 | 481 | $58K | $100 | $39 | 2.6x | 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 | 528 | 184 | $42K | $213 | $117 | 1.8x | 2.3x (90th percentile 3.8x) |
| 99306 | Initial nursing facility care with high level of medical decision making, per day, if using time, 50 minutes or more | 251 | 245 | $35K | $450 | $174 | 2.6x | 1.9x (90th percentile 3.1x) |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | 357 | 162 | $20K | $145 | $83 | 1.7x | 2.2x (90th percentile 3.8x) |
| 90792 | Psychiatric diagnostic evaluation with medical services | 86 | 74 | $11K | $400 | $164 | 2.4x | 2.2x (90th percentile 3.9x) |
| 99309 | Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes | 126 | 99 | $10K | $265 | $103 | 2.6x | 2.0x (90th percentile 3.3x) |
| 90791 | Psychiatric diagnostic evaluation | 33 | 33 | $4K | $352 | $166 | 2.1x | 1.9x (90th percentile 3.6x) |
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 Rockwall County, TX 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 | SUNRISE HOME HEALTH SERVICES OF AMERICA, INC. Rockwall, TX, ranked 4696 | $0 |
|
| 3 | RADIANT CARE HOSPICE LLC Rockwall, TX, ranked 4824 | $0 |
|
Recent enforcement in TX
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
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.