HISHAM SAAD SADEK, MD

HISHAM SADEK is an individual provider in Chicago, Illinois, with a psychiatry taxonomy and Illinois as the Medicaid home state. Indiana Medicaid placed this provider on its termination list on July 15, 2015. Records show Medicaid paid $2,029,469 to this provider across 54 service months between May 2020 and November 2024, while nothing was paid in the 12 months before the Indiana action. Medicare separately revoked the provider on August 6, 2025 for failure to report and for another program termination, with a bar on re-enrollment until January 14, 2031. Within Medicaid, the largest paid codes are office visits at high, low and moderate levels of decision making, and the per patient per month amounts for those codes rank at the 93rd, 94th and 94th percentiles compared with other providers billing the same codes.

1. 01NPI 1619941614 is listed in NPPES as HISHAM SADEK, an individual in Chicago, IL, with taxonomy 2084P0800X and Illinois as the Medicaid home state. records 1
2. 02The provider has been listed on the Indiana Medicaid exclusion list since July 15, 2015, and Medicaid still paid claims in 54 later months totaling $2,029,469. records 12
3. 03After the Indiana state exclusion action of July 15, 2015, taken from the Indiana Family and Social Services Administration terminations file, Medicaid paid $2,029,469 across 54 service months from May 2020 through November 2024, and $0 in the 12 months before. records 14
4. 04Medicare revoked the provider on August 6, 2025 under 424.535(A)(9) Failure To Report and 424.535(A)(12) Other Program Termination (Medicaid), with a re-enrollment bar to January 14, 2031. records 13
5. 05Code 99215 accounts for $666,791 paid over 32 months, 33 percent of this provider's Medicaid dollars, at $186 per patient-month, the 93rd percentile among providers billing this code, where typical is $88, and this code family has a history of abuse. records 2
6. 06Code 99213 accounts for $572,204 paid over 46 months, 28 percent of this provider's Medicaid dollars, at $101 per patient-month, the 94th percentile among providers billing this code, where typical is $44. records 3
7. 07Code 99214 accounts for $151,844 paid over 16 months, 7 percent of this provider's Medicaid dollars, at $127 per patient-month, the 94th percentile among providers billing this code, where typical is $60. records 6
8. 08Code 90792 accounts for $202,708 paid over 45 months, 10 percent of Medicaid dollars, at $159 per patient-month, the 75th percentile, where typical is $112; code 90836 accounts for $176,186 over 34 months, 9 percent of Medicaid dollars, at $114 per patient-month, the 81st percentile, where typical is $72. records 4, 5
9. 09Code T1016 case management accounts for $97,730 paid over 7 months, 5 percent of this provider's Medicaid dollars, at $229 per patient-month, the 78th percentile, where typical is $98. records 7
10. 10In Medicare 2024 the provider billed 433 services of code 99213 for 75 beneficiaries with $26,494 paid, 33 services of code 99443 for 24 beneficiaries with $3,119 paid, 18 services of code 90792 for 18 beneficiaries with $2,395 paid, and 19 services of code 99214 for 14 beneficiaries with $1,783 paid. records 8, 9, 10, 11
11. 11The risk record is evidence tier 1 (documented action, then payment) with detectors D3 and D2 and dollars at risk of $2,029,469, described as the figure of the detector that set the tier and not a sum. records 12

Request from the Illinois Medicaid agency and any contracted managed care plans the full enrollment file, revalidation history and screening logs for NPI 1619941614, plus the claim level detail for the 54 service months from May 2020 through November 2024 that total $2,029,469. Confirm whether the Indiana Medicaid termination of July 15, 2015 appears in the termination database and whether denial or termination of enrollment was required under 42 CFR 455.416(c). Document the monthly exclusion and identity screening required by 42 CFR 455.436, including NPPES, the Social Security Death Master File, the List of Excluded Individuals and Entities and SAM, and identify the months in which the Indiana action should have surfaced. Obtain the Medicare revocation record dated August 6, 2025 citing 424.535(a)(9) and 424.535(a)(12) with the bar to January 14, 2031, and reconcile it against the grounds in 42 CFR 424.535(a). Pull medical records and time documentation for a sample of 99215, 99213 and 99214 claims, given the 93rd and 94th percentile per patient-month figures, to test level of service support. If the review establishes a credible allegation of fraud, apply the payment suspension analysis under 42 CFR 455.23(a) and make the referral to the Medicaid Fraud Control Unit required by 42 CFR 455.23(d).

• The Indiana Medicaid termination may have been appealed, reversed or reinstated after July 15, 2015, and the state file extracted from the Indiana Family and Social Services Administration terminations spreadsheet may not reflect a later change in status.
• A termination in Indiana Medicaid does not by itself bar enrollment or payment in Illinois Medicaid; the Illinois agency may have made an independent enrollment determination that must be reviewed before any conclusion.
• Identity matching is based on name and NPI; the exclusion list entry should be confirmed against date of birth, Social Security number or other identifiers to rule out a similar name match.
• Payments in the 54 service months may include claims billed under a group or supervising arrangement, or claims with dates of service or adjudication dates that differ from the service months shown, so payment attribution needs verification.
• Data lag and retroactive adjustments in T-MSIS and Medicare files can shift both service months and paid amounts, and the $0 paid in the 12 months before the action may reflect absence of data rather than absence of activity.
• High percentile per patient-month amounts for office visit codes can reflect a severely ill psychiatric caseload, long visit times or a narrow patient panel, and are not by themselves evidence of incorrect coding.
• The Medicare revocation dated August 6, 2025 under failure to report and other program termination may be under appeal or subject to a corrective action plan, and the re-enrollment bar to January 14, 2031 could change as a result.
• Medicare submitted to allowed ratios for this provider are below the usual ratios for the same codes, which cuts against an inflated charge pattern.