POLLY MARIE VAUGHN
NPI 1750754008, individual, Bourbonnais, IL, Counselor, Professional
- Hours beyond a day in 2 months under one organization, which can be supervisory billing.
- Records needed.
- Medicaid dollars per patient on code 90837 ($1140 per patient-month) sit in the top 5% of every provider billing that code.
- 100% of Medicaid dollars are on codes with a history of abuse.
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 |
|---|---|---|---|---|---|---|---|---|---|
| Apr 2020 | More hours than a day holds, even counting one unit per claim line | 31.0 | 28.1 | 18.7 | 25.5 | 27 | 1 | 90837 | $66K |
| May 2020 | More hours than a day holds, even counting one unit per claim line | 24.3 | 21.8 | 14.5 | 21.4 | 22 | 1 | 90837 | $53K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | POLLY MARIE VAUGHN |
| Type | Individual, sole proprietor |
| Status | Active |
| NPI issued | November 9, 2015, last updated June 7, 2023 |
| Practice location | 206 CHESTERFIELD CT, Bourbonnais, IL 60914-9652, 815-603-2425 |
| Mailing address | PO BOX 2199, Kankakee, IL 60901-1199 |
| Specialties | Counselor, Professional (101YP2500X, primary, license 180009894 IL) |
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.
| code | what it is | paid | share | per patient-month | typical | rank among providers | |
|---|---|---|---|---|---|---|---|
| 90837 | Psychotherapy, 1 hourhistory of abuse | $1.2M | 100% | $1K | $191 (top 5% from $442) | 100th percentile |
In this area
2 providers in Kankakee County, IL carry an indicator in the public record, with $1.7M at stake between them. The most common is part of a provider network, on 1 of them, followed by more hours than a day holds on 1.
| tier | provider | at stake | why |
|---|---|---|---|
| 3 | PRESENCE HOME CARE Kankakee, IL, ranked 1363 | $93K |
|
| 5 | EYAD ALHAJ Bourbonnais, IL, ranked 10879 | $1.6M |
Recent enforcement in IL
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
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.