Providers
THOMAS GREGORY HUGHES, M.D.
NPI 1689668642, individual, Bowling Green, KY, Internal Medicine
1
Evidence tier
documented action, then payment
- Listed on the IN Medicaid exclusion list since November 30, 2016.
- Medicaid still paid claims in 42 later months, $151,689 in total.
score 95 of 100, rank 121, $152K at stake
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 |
|---|---|---|---|---|---|---|---|---|
| IN Medicaid exclusion list state list extracted from https://www.in.gov/fssa/ompp/files/ompp terminations.xlsx (pandas claude colmap) | Exact NPI, name verified | Nov 30, 2016 | still open | 42 | Jan 2020 | Jun 2023 | $152K | $0 |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | THOMAS GREGORY HUGHES, M.D. |
| Type | Individual |
| Status | Active |
| NPI issued | September 7, 2005, last updated October 21, 2019 |
| Practice location | 225 NATCHEZ TRACE AVE, Bowling Green, KY 42103, 270-783-3573 |
| Specialties | Internal Medicine (207R00000X, primary, license 34678 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 | |
|---|---|---|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | $122K | 81% | $41 | $44 (top 5% from $110) | 45th percentile | |
| 99203 | New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more | $28K | 19% | $69 | $67 (top 5% from $121) | 53rd percentile | |
| 90471 | Administration of vaccine | $440 | 0% | $8.80 | $10 (top 5% from $23) | too few months to rank | |
| 90688 | Influenza vaccine, quadrivalent, 0.5 ml dosage | $405 | 0% | $14 | $5.67 (top 5% from $19) | too few months to rank | |
| 81003 | Automated urinalysis test | $9 | 0% | $0.37 | $1.54 (top 5% from $4.70) | too few months to rank | |
| 3074F | Medicaid service code | $2 | 0% | $0.00 | $0.00 (top 5% from $1.18) | 80th percentile | |
| 3079F | Medicaid service code | $1 | 0% | $0.00 | $0.00 (top 5% from $1.06) | 81st percentile | |
| 3078F | Medicaid service code | $1 | 0% | $0.00 | $0.00 (top 5% from $0.82) | 82nd percentile |
In this area
6 providers in Warren County, KY carry an indicator in the public record, with $10.7M 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 1. 2 are tier 1: documented action, then payment.
| tier | provider | at stake | why |
|---|---|---|---|
| 1 | ACCULAB, LLC Bowling Green, KY, ranked 278 | $12K |
|
| 1 | ZIA NEUROLOGY ASSOCIATES, LLC Bowling Green, KY, ranked 299 | $8K |
|
| 4 | MICHELLE CONNER Bowling Green, KY, ranked 8479 | $3.7M |
|
| 4 | KIMBERLY WILSON Bowling Green, KY, ranked 8616 | $2.6M |
|
| 4 | KRISTINA FULLER Bowling Green, KY, ranked 8632 | $2.5M |
|
| 5 | EMILY EDWARDS Bowling Green, KY, ranked 10829 | $1.9M |
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.