Providers
MOHAMAD SAMAH KALOU, md
NPI 1619065190, individual, Charleston, WV, Family Medicine, Addiction Medicine
4
Evidence tier
structure or single-organization volume
- Hours beyond a day in 17 months, but with up to 2967 patients a month, which points to a supervising clinician on the claims rather than one person's hours.
- Records needed.
- Medicaid dollars per patient on code 80307 ($183 per patient-month) sit in the top 5% of every provider billing that code.
score 56 of 100, rank 7525, $3.4M 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 |
|---|---|---|---|---|---|---|---|---|---|
| Oct 2018 | More hours than a day holds at a conservative unit price | 10.9 | 38.0 | 25.4 | 34.2 | 479 | 1 | 99204 99205 99213 99214 99401 99406 | $144K |
| Jul 2020 | More hours than a day holds, even counting one unit per claim line | 31.8 | 28.1 | 18.7 | 25.2 | 930 | 1 | 99204 99205 99213 99214 99407 | $106K |
| Aug 2020 | More hours than a day holds, even counting one unit per claim line | 38.5 | 20.6 | 13.7 | 20.2 | 996 | 1 | 99203 99204 99205 99213 99214 99407 | $78K |
| Sep 2020 | More hours than a day holds, even counting one unit per claim line | 35.8 | 24.0 | 16.0 | 21.8 | 996 | 1 | 99204 99205 99213 99214 99407 | $88K |
| Oct 2020 | More hours than a day holds, even counting one unit per claim line | 37.8 | 23.6 | 15.8 | 22.2 | 1303 | 1 | 99203 99204 99205 99212 99213 99214 99407 99441 | $89K |
| Nov 2020 | More hours than a day holds, even counting one unit per claim line | 50.5 | 25.5 | 17.0 | 24.3 | 1391 | 1 | 99203 99204 99205 99212 99213 99214 99407 99441 99442 | $94K |
| Dec 2020 | More hours than a day holds, even counting one unit per claim line | 45.3 | 27.3 | 18.2 | 24.5 | 1760 | 1 | 99203 99204 99205 99212 99213 99214 99407 99441 99442 | $102K |
| Jan 2021 | More hours than a day holds, even counting one unit per claim line | 55.2 | 37.8 | 25.2 | 37.2 | 2459 | 1 | 99203 99204 99205 99212 99213 99214 99407 99408 99441 99442 | $113K |
| Feb 2021 | More hours than a day holds, even counting one unit per claim line | 44.7 | 30.2 | 20.1 | 28.2 | 1758 | 1 | 99203 99204 99205 99212 99213 99214 99406 99407 99408 99442 | $93K |
| Mar 2021 | More hours than a day holds, even counting one unit per claim line | 62.5 | 34.6 | 23.1 | 31.1 | 2123 | 1 | 99203 99204 99205 99212 99213 99214 99407 99408 99441 99442 | $118K |
| Apr 2021 | More hours than a day holds, even counting one unit per claim line | 79.7 | 48.5 | 32.3 | 44.1 | 2403 | 1 | 99203 99204 99205 99212 99213 99214 99407 99408 99441 99442 | $161K |
| May 2021 | More hours than a day holds, even counting one unit per claim line | 65.3 | 36.0 | 24.0 | 35.4 | 2378 | 1 | 99203 99205 99212 99213 99214 99407 99408 99442 | $123K |
| Jun 2021 | More hours than a day holds, even counting one unit per claim line | 67.6 | 42.0 | 28.0 | 38.2 | 2182 | 1 | 99203 99205 99212 99213 99214 99407 99408 99442 | $137K |
| Jul 2021 | More hours than a day holds, even counting one unit per claim line | 48.0 | 47.1 | 31.4 | 44.2 | 2223 | 1 | 90832 99203 99205 99212 99213 99214 99215 99407 99408 99441 99442 | $161K |
| Aug 2021 | More hours than a day holds, even counting one unit per claim line | 48.6 | 48.8 | 32.5 | 45.8 | 2327 | 1 | 90832 99203 99204 99205 99212 99213 99214 99407 99408 99441 99442 | $167K |
| Sep 2021 | More hours than a day holds, even counting one unit per claim line | 74.7 | 71.1 | 47.4 | 64.7 | 2967 | 1 | 99202 99203 99204 99205 99212 99213 99214 99407 99408 99441 99442 | $227K |
| Oct 2021 | More hours than a day holds, even counting one unit per claim line | 44.2 | 53.0 | 35.3 | 52.1 | 2445 | 1 | 99203 99204 99205 99212 99213 99214 99407 99408 99441 99442 | $175K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | MOHAMAD SAMAH KALOU, md |
| Type | Individual, sole proprietor |
| Status | Active |
| NPI issued | October 10, 2006, last updated August 26, 2020 |
| Practice location | 5240 MACCORKLE AVE SE, Charleston, WV 25304-2122, 304-926-2300 |
| Mailing address | 500 POPLAR ST, SUITE 204, South Charleston, WV 25309-1474 |
| Specialties | Family Medicine (207Q00000X, license 22493 WV) Family Medicine (207Q00000X, license 35.088590 OH) Family Medicine, Addiction Medicine (207QA0401X, primary, license 22493 WV) |
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 | $2.7M | 25% | $124 | $44 (top 5% from $110) | 96th percentile | |
| G0482 | 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 | $2.4M | 23% | $206 | $133 (top 5% from $245) | 88th percentile | |
| 80307 | Testing for presence of drug, by chemistry analyzers | $2.2M | 20% | $183 | $45 (top 5% from $110) | 99th percentile | |
| 82075 | Measurement of alcohol level in breath specimen | $920K | 9% | $66 | $29 (top 5% from $75) | 94th percentile | |
| G0483 | 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 | $438K | 4% | $494 | $146 (top 5% from $318) | 98th percentile | |
| G0481 | 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 | $415K | 4% | $162 | $98 (top 5% from $199) | 89th percentile | |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $367K | 3% | $110 | $60 (top 5% from $133) | 90th 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 | $141K | 1% | $30 | $58 (top 5% from $129) | 30th 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 |
|---|---|---|---|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | 170 | 47 | $9K | $120 | $77 | 1.6x | 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 | 96 | 31 | $7K | $166 | $112 | 1.5x | 2.3x (90th percentile 3.8x) |
| 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 | 61 | 15 | $7K | $125 | $112 | 1.1x | 2.7x (90th percentile 6.1x) |
| 80307 | Testing for presence of drug, by chemistry analyzers | 62 | 14 | $4K | $150 | $61 | 2.5x | 3.2x (90th percentile 7.6x) |
| 99212 | Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more | 21 | 14 | $664 | $69 | $45 | 1.5x | 2.2x (90th percentile 3.8x) |
| 96372 | Injection of drug or substance under skin or into muscle | 51 | 22 | $391 | $22 | $12 | 1.8x | 3.6x (90th percentile 6.4x) |
| 99406 | Smoking and tobacco use intensive counseling, 4-10 minutes | 30 | 24 | $372 | $23 | $12 | 1.9x | 2.5x (90th percentile 4.4x) |
| J3420 | Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg | 33 | 14 | $28 | $10 | $1 | 7.5x | 8.0x (90th percentile 21.5x) |
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
7 providers in Kanawha County, WV carry an indicator in the public record, with $921K at stake between them. The most common is more hours than a day holds, on 4 of them, followed by named in an enforcement record on 2. 3 are tier 1: documented action, then payment.
| tier | provider | at stake | why |
|---|---|---|---|
| 1 | SHAWN BLANKENSHIP Charleston, WV, ranked 289 | $0 |
|
| 1 | HUGH SMITH Charleston, WV, ranked 314 | $6K |
|
| 1 | HOLISTIC, INC Charleston, WV, ranked 557 | $0 |
|
| 3 | HARRELL NURSING HOME Charleston, WV, ranked 2693 | $0 |
|
| 5 | NITIN SANGRAMPURKAR Charleston, WV, ranked 10478 | $72K |
|
| 5 | SAMANTHA SHAWVER Charleston, WV, ranked 11091 | $825K | |
| 5 | JENNIFER PRICE Charleston, WV, ranked 11891 | $17K |
Recent enforcement in WV
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
DOJCivil settlementJun 23, 2026
Northern District of West Virginia Part of National Health Care Fraud Takedown Resulting in 455 Defendants Charged in Connection with Over $6.5 Billion in Alleged Fraud
Two providers reached civil settlements resolving allegations that they used pre-signed, invalid prescriptions issued outside the usual course of their professional practice to patients in West Virginia while traveling and not in close proximity to their offices, and in one case submitted claims to Medicare and Medicaid during that time.
DOJComplaint filedJun 23, 2026
U.S. Attorney Moore Capito Announces Fraud Conspiracy Charges Against Sober Living Home Founder and Spouse
Two individuals affiliated with a sober living recovery program allegedly conspired to falsify and submit timesheets to a testing laboratory for drug testing work not performed, and the laboratory paid the billings and obtained reimbursement from federal and state healthcare programs; separately, a sleep laboratory paid $120,000 to resolve allegations it billed Medicaid and the VA Community Health program for sleep studies and polysomnogram reports prepared and signed by unqualified, non-physician staff.
DOJPleaded guiltyJun 17, 2026
Mercer County Woman Pleads Guilty to $175,731.31 Fraud Scheme Targeting Federal Veterans Health Care Benefits
Radford, an owner of Healthcare Therapy Services LLC doing business as Medical Massage Therapy, submitted false bills to CHAMPVA for massage services not rendered, stealing $175,731.31.
DOJCivil settlementMar 5, 2026
Laboratory Agrees to Pay More than $200,000 for Improper Billing to West Virginia Medicaid Program
Integra repeatedly submitted billings to the West Virginia Medicaid program for medically unnecessary testing ordered by medical providers over a two-year period, specifically improper claims for specimen validity testing that were not allowable.
DOJCivil settlementApr 2, 2025
Beckley Medical Clinic and Physician Agree to Pay $152,382.70 to Resolve False Claims Act Allegations
Med-Surg and its owner submitted claims to Medicare and Medicaid using HCPCS code Q3014 for the telehealth originating site facility fee for telehealth visits where the patient was at home, which is not payable.
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.