Providers
All 9 in WA
JAMES MATTHEWS, EdS, MA, BCBA
NPI 1740600196, individual, Spokane, WA, Behavior Analyst
5
Evidence tier
informational
- 84% of Medicaid dollars are on codes with a history of abuse.
score 34 of 100, rank 10448, $11.8M at stake
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | JAMES MATTHEWS, EdS, MA, BCBA |
| Type | Individual |
| Status | Active |
| NPI issued | April 24, 2014, last updated June 3, 2016 |
| Practice location | 1858 E 8TH AVE, Spokane, WA 99202-3410, 509-999-5657 |
| Specialties | Behavior Analyst (103K00000X, primary) |
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 | |
|---|---|---|---|---|---|---|---|
| 97153 | Adaptive behavior treatment by protocol by technicianhistory of abuse | $14.9M | 78% | $2K | $2K (top 5% from $6K) | 62nd percentile | |
| 97155 | Adaptive behavior treatment with protocol modification by QHPhistory of abuse | $1.2M | 6% | $203 | $512 (top 5% from $1K) | 9th percentile | |
| 0365T | Adaptive behavior treatment by protocol each addl 30 min (pre-2019) | $1.2M | 6% | $2K | $2K (top 5% from $4K) | 58th percentile | |
| H2020 | Therapeutic behavioral services per diem | $775K | 4% | $6K | $455 (top 5% from $2K) | 100th percentile | |
| 97151 | Behavior identification assessment by professional, each 15 minutes | $472K | 2% | $255 | $389 (top 5% from $1K) | 28th percentile | |
| 0364T | Adaptive behavior treatment by protocol first 30 min (pre-2019) | $220K | 1% | $324 | $303 (top 5% from $1K) | 59th percentile | |
| 97156 | Family adaptive behavior treatment guidance | $212K | 1% | $79 | $210 (top 5% from $547) | 10th percentile | |
| 0368T | Adaptive behavior treatment with protocol modification first 30 min (pre-2019) | $41K | 0% | $71 | $192 (top 5% from $534) | 8th percentile |
In this area
9 providers in Spokane County, WA carry an indicator in the public record, with $6.9M at stake between them. The most common is more hours than a day holds, on 6 of them, followed by part of a provider network on 3.
| tier | provider | at stake | why |
|---|---|---|---|
| 3 | SPOKANE UNITED METHODIST HOMES Spokane, WA, ranked 2645 | $0 |
|
| 3 | AVALON CARE CENTER - SPOKANE LLC Spokane, WA, ranked 3670 | $0 |
|
| 3 | EDEN HOME HEALTH OF SPOKANE COUNTY, LLC Spokane Valley, WA, ranked 5198 | $0 |
|
| 4 | PAUL MEANS Spokane, WA, ranked 7640 | $2.3M |
|
| 4 | JULIE CHRISTIANSEN Deer Park, WA, ranked 7787 | $1.3M |
|
| 5 | NICOLE MANWILLER Spokane Valley, WA, ranked 10018 | $1.6M |
|
| 5 | MATTHEW KILGORE Spokane, WA, ranked 10240 | $544K |
|
| 5 | NORA LAUGHLIN Spokane, WA, ranked 10573 | $990K |
|
Recent enforcement in WA
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
DOJSentencedMar 27, 2026
Local Physician Sentenced to 1 Year Imprisonment, a $60,000 fine, and Restitution of $349,272.79 for Adulterating and Misbranding Medical Devices with the Intent to Defraud
Haeger purchased over 500 used and recalled CPAP and BiPAP devices, had the sound abatement foam removed outside clean room conditions, provided the devices to Washington State Medicaid patients through his sleep clinic, and billed Medicaid representing them as new devices in good working order.
DOJCivil settlementJan 12, 2026
DOJ and Seattle-based FidaLab, LLC settle allegations it inflated bills to government health care programs
FidaLab billed Medicare for a series of urinary tract infection tests under multiple billing codes instead of a single code after its request to bill the tests as a panel was denied.
DOJPleaded guiltyDec 18, 2025
Local Physician Pleads Guilty to Adulterating and Misbranding Medical Devices with the Intent to Defraud
Physician purchased over 500 used and recalled CPAP and BiPAP devices, had the sound abatement foam removed outside of clean room conditions, provided the devices to Washington State Medicaid patients, and had staff bill Medicaid representing them as new devices in good working order.
DOJCivil settlementDec 10, 2025
Spokane Physician Pays $120,000 to Resolve Allegations He Prescribed Controlled Substances Without Legitimate Medical Purpose
Between 2017 and 2025 a licensed physician issued over 1,400 prescriptions for controlled substances to thirteen identified patients that lacked legitimate medical purposes or were outside the usual course of professional practice, failing to address red flags of substance abuse.
DOJSentencedDec 2, 2025
Indian national sentenced to prison for Medicare fraud scheme that stole more than $1 million in taxpayer funds
Asif conspired with others to bill Medicare for COVID-19 tests and other respiratory illness tests that had not been ordered or performed through American Labworks LLC.
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.