Providers

THOMAS E. TUELLER, LCSW

NPI 1740321314, individual, Idaho Falls, ID, Social Worker, Clinical

4
Evidence tier
structure or single-organization volume
  • Hours beyond a day in 7 months, but with up to 1005 patients a month, which points to a supervising clinician on the claims rather than one person's hours.
  • Records needed.
score 52 of 100, rank 8394, $5.3M 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.

monthwhat was foundhours per day, lower boundhours per day, at pricehours per day, conservativeper working daypatientsbilling organizationscodespaid
Jan 2018More hours than a day holds, even counting one unit per claim line39.344.729.824.9952190791 90832 90834 90846 90847 90853 H0038 H2017 T1017$164K
Feb 2018More hours than a day holds, even counting one unit per claim line40.546.030.725.4967190791 90832 90834 90846 90847 90853 H0038 H2017 S5150 T1017$156K
Mar 2018More hours than a day holds, even counting one unit per claim line39.144.429.624.11005190791 90832 90834 90846 90847 90853 H0038 H2017 S5150 T1017$169K
Apr 2018More hours than a day holds, even counting one unit per claim line40.245.030.024.5972190791 90832 90834 90846 90847 H0038 H2017 S5150 T1017$167K
May 2018More hours than a day holds, even counting one unit per claim line38.643.829.221.6948190791 90832 90834 90846 90847 H0038 H2017 S5150 T1017$169K
Jan 2023More hours than a day holds, even counting one unit per claim line35.347.131.422.6963190791 90832 90834 90837 90847 90853 H0038 H2017 T1017$211K
Feb 2023More hours than a day holds, even counting one unit per claim line37.949.633.124.7961190791 90832 90834 90837 90847 90853 H0038 H2017 T1017$199K

National provider registry

From the CMS NPPES Registry, refreshed daily.

NameTHOMAS E. TUELLER, LCSW
TypeIndividual, sole proprietor
StatusActive
NPI issuedFebruary 8, 2007, last updated May 9, 2022
Practice location2275 W BROADWAY ST STE G, Idaho Falls, ID 83402-2902, 208-524-7400
Specialties
Social Worker, Clinical (1041C0700X, primary, license LCSW-859 ID)

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
codewhat it ispaidshareper patient-monthtypicalrank among providers
H2017Psychosocial rehabilitation services per 15 minhistory of abuse$1.7M26%$441$310 (top 5% from $1K)67th percentile
T1017Targeted case management each 15 min$1.0M16%$165$167 (top 5% from $808)50th percentile
90834Psychotherapy, 45 minutes$751K11%$123$101 (top 5% from $318)62nd percentile
H0038Self-help/peer services per 15 min$729K11%$333$147 (top 5% from $2K)73rd percentile
H0046Medicaid service code$448K7%$209$60 (top 5% from $2K)64th percentile
H0031Medicaid service code$353K5%$171$100 (top 5% from $540)73rd percentile
S5150Unskilled respite care per 15 min$325K5%$260$709 (top 5% from $2K)12th percentile
90847Family psychotherapy with patient, 50 minutes$308K5%$120$130 (top 5% from $458)45th percentile

In this area

5 providers in Bonneville County, ID carry an indicator in the public record, with $4.8M at stake between them. The most common is part of a provider network, on 3 of them, followed by more hours than a day holds on 2.

tierproviderat stakewhy
3EDEN HOME HEALTH OF IDAHO FALLS, LLC
Idaho Falls, ID, ranked 2356
$0
  • Part of provider network D1-00079, ranked 79 nationally.
3EDEN HOSPICE AT IDAHO FALLS, LLC
Idaho Falls, ID, ranked 4976
$0
  • Part of provider network D1-00079, ranked 79 nationally.
3OAKSTONE HOSPICE LLC
Idaho Falls, ID, ranked 5393
$0
  • Part of provider network D1-00098, ranked 98 nationally.
5BRETT HAMPTON
Idaho Falls, ID, ranked 9925
$2.9M
  • Medicaid dollars per patient on code H0005 ($580 per patient-month) sit in the top 5% of every provider billing that code.
5STEVEN ORME
Idaho Falls, ID, ranked 9978
$1.9M
  • Medicaid dollars per patient on code H0005 ($908 per patient-month) sit in the top 5% of every provider billing that code.

Recent enforcement in ID

All releases

Department of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.

DOJCivil settlementOct 29, 2024
Boise Health Care Company and Former Therapist Resolve Fraudulent Psychotherapy Billing Allegations Involving Vulnerable Refugee Population
KA Health Services and its owner paid $321,576.51 to resolve allegations they submitted false Medicaid claims for psychotherapy, language interpretation, and other services that were never provided or not provided by a qualified professional, and a former counselor consented to a $40,000 judgment after admitting she directed unqualified interpreters to meet with refugee clients and signed false medical records.
DOJCivil settlementApr 3, 2024
Pocatello Doctor Pays $96,000 to Settle Allegations That He Wrote Unlawful Prescriptions
The government alleged that Knouf wrote prescriptions for controlled substances that lacked a legitimate medical purpose and/or were issued outside the usual course of professional practice, prescribed dangerous combinations of drugs, and billed Medicare and Medicaid for services that were not performed.
DOJCivil judgmentJan 17, 2024
AmeriHealth Clinics Consent to a $2 Million Judgment to Resolve Healthcare Fraud Allegations
AmeriHealth and its owners hired vulnerable, compromised, and inexperienced medical staff who were pressured into providing unnecessary and worthless care, resulting in false claims to federal health care programs, and also allegedly pressured practitioners to prescribe controlled substances, entered a kickback scheme with a third-party laboratory, and falsely certified information to obtain PPP loan forgiveness.

Referral packet

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