Providers
All 32 in NY
PRITI JAIN, M.D.
NPI 1780607333, individual, Hicksville, NY, Internal Medicine
4
Evidence tier
structure or single-organization volume
- Hours beyond a day in 6 months, but with up to 2000 patients a month, which points to a supervising clinician on the claims rather than one person's hours.
- Records needed.
- Medicaid dollars per patient on code S9083 ($172 per patient-month) sit in the top 5% of every provider billing that code.
score 56 of 100, rank 7545, $3.2M 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.
| 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 |
|---|---|---|---|---|---|---|---|---|---|
| Nov 2020 | More hours than a day holds, even counting one unit per claim line | 31.1 | 53.5 | 35.7 | 51.0 | 1423 | 1 | 99204 99213 99214 99406 | $178K |
| Dec 2020 | More hours than a day holds, even counting one unit per claim line | 53.4 | 88.9 | 59.3 | 79.9 | 2410 | 1 | 99203 99204 99213 99214 99215 | $307K |
| Jan 2021 | More hours than a day holds, even counting one unit per claim line | 58.8 | 106.5 | 71.0 | 104.9 | 2986 | 1 | 99203 99204 99212 99213 99214 99215 | $377K |
| Feb 2021 | More hours than a day holds at a conservative unit price | 18.4 | 37.3 | 24.9 | 34.8 | 1140 | 1 | 99203 99204 99212 99213 99214 | $124K |
| Mar 2021 | More hours than a day holds, even counting one unit per claim line | 28.9 | 62.3 | 41.5 | 56.0 | 1945 | 1 | 99203 99204 99212 99213 99214 99401 | $230K |
| Apr 2021 | More hours than a day holds, even counting one unit per claim line | 37.1 | 87.5 | 58.3 | 79.6 | 2392 | 1 | 99203 99204 99212 99213 99214 | $311K |
| May 2021 | More hours than a day holds, even counting one unit per claim line | 31.2 | 74.5 | 49.7 | 73.3 | 1980 | 1 | 99203 99204 99212 99213 99214 | $271K |
| Jun 2021 | More hours than a day holds, even counting one unit per claim line | 32.4 | 77.7 | 51.8 | 70.6 | 2091 | 1 | 99203 99204 99212 99213 99214 99401 | $274K |
| Jul 2021 | More hours than a day holds, even counting one unit per claim line | 29.7 | 72.5 | 48.3 | 68.1 | 2009 | 1 | 99203 99204 99212 99213 99214 | $267K |
| Aug 2021 | More hours than a day holds, even counting one unit per claim line | 37.5 | 89.6 | 59.7 | 84.2 | 2512 | 1 | 99203 99204 99212 99213 99214 | $330K |
| Sep 2021 | More hours than a day holds, even counting one unit per claim line | 39.7 | 97.0 | 64.7 | 88.2 | 2520 | 1 | 99203 99204 99212 99213 99214 | $346K |
| Oct 2021 | More hours than a day holds, even counting one unit per claim line | 36.6 | 93.0 | 62.0 | 91.6 | 2380 | 1 | 99203 99204 99212 99213 99214 | $343K |
| Nov 2021 | More hours than a day holds, even counting one unit per claim line | 32.8 | 81.5 | 54.4 | 74.1 | 2128 | 1 | 99203 99204 99212 99213 99214 99215 | $290K |
| Dec 2021 | More hours than a day holds, even counting one unit per claim line | 51.5 | 130.9 | 87.2 | 117.6 | 3554 | 1 | 99203 99204 99212 99213 99214 | $482K |
| Jan 2022 | More hours than a day holds, even counting one unit per claim line | 47.4 | 123.1 | 82.1 | 121.2 | 3166 | 1 | 99203 99204 99213 99214 | $451K |
| Mar 2022 | More hours than a day holds at a conservative unit price | 19.3 | 48.7 | 32.5 | 43.8 | 1233 | 1 | 99203 99204 99212 99213 99214 99215 | $175K |
| Apr 2022 | More hours than a day holds at a conservative unit price | 22.0 | 57.6 | 38.4 | 54.9 | 1336 | 1 | 99203 99204 99213 99214 | $202K |
| May 2022 | More hours than a day holds, even counting one unit per claim line | 28.4 | 68.8 | 45.9 | 64.7 | 1895 | 1 | 99203 99204 99213 99214 G0444 | $251K |
| Jun 2022 | More hours than a day holds, even counting one unit per claim line | 26.3 | 59.8 | 39.9 | 54.4 | 1766 | 1 | 99203 99204 99212 99213 99214 99401 G0444 | $210K |
| Jul 2022 | More hours than a day holds, even counting one unit per claim line | 28.3 | 63.3 | 42.2 | 62.3 | 1994 | 1 | 99203 99204 99212 99213 99214 99215 99401 G0444 | $230K |
| Aug 2022 | More hours than a day holds at a conservative unit price | 19.0 | 44.2 | 29.5 | 39.7 | 1415 | 1 | 99203 99204 99212 99213 99214 99401 G0444 | $159K |
| Sep 2022 | More hours than a day holds, even counting one unit per claim line | 24.9 | 59.5 | 39.7 | 54.1 | 1703 | 1 | 99203 99204 99212 99213 99214 99401 G0444 | $209K |
| Oct 2022 | More hours than a day holds at a conservative unit price | 23.3 | 56.9 | 37.9 | 56.0 | 1618 | 1 | 99203 99204 99212 99213 99214 G0444 | $207K |
| Nov 2022 | More hours than a day holds, even counting one unit per claim line | 28.0 | 64.8 | 43.2 | 59.0 | 1875 | 1 | 99203 99204 99212 99213 99214 99215 G0444 | $226K |
| Dec 2022 | More hours than a day holds at a conservative unit price | 21.2 | 48.6 | 32.4 | 45.6 | 1494 | 1 | 99203 99204 99212 99213 99214 G0444 | $176K |
| Mar 2023 | More hours than a day holds at a conservative unit price | 21.3 | 49.7 | 33.2 | 44.7 | 1374 | 1 | 99203 99204 99212 99213 99214 99441 G0444 | $174K |
| Apr 2023 | More hours than a day holds at a conservative unit price | 18.8 | 43.9 | 29.3 | 43.9 | 1212 | 1 | 99203 99204 99212 99213 99214 99401 99441 99442 G0444 | $148K |
| May 2023 | More hours than a day holds, even counting one unit per claim line | 24.7 | 51.3 | 34.2 | 46.1 | 1529 | 1 | 99203 99204 99212 99213 99214 99215 99401 99408 99441 G0444 G0447 | $175K |
| Jun 2023 | More hours than a day holds at a conservative unit price | 23.2 | 48.2 | 32.1 | 43.8 | 1397 | 1 | 99203 99204 99205 99212 99213 99214 99215 99401 G0444 G0447 | $158K |
| Jul 2023 | More hours than a day holds at a conservative unit price | 19.3 | 39.7 | 26.5 | 39.1 | 1160 | 1 | 99203 99204 99212 99213 99214 99215 99401 G0444 G0447 | $135K |
| Aug 2023 | More hours than a day holds, even counting one unit per claim line | 24.0 | 42.1 | 28.0 | 37.8 | 1629 | 1 | 90791 96138 99203 99204 99213 99214 99215 99401 99408 G0444 G0447 | $142K |
| Sep 2023 | More hours than a day holds at a conservative unit price | 22.1 | 46.2 | 30.8 | 44.0 | 1272 | 1 | 90791 99203 99204 99213 99214 99215 99401 99406 99408 G0444 G0447 | $151K |
| Oct 2023 | More hours than a day holds at a conservative unit price | 21.8 | 44.2 | 29.5 | 41.5 | 1341 | 1 | 90791 96138 99203 99204 99213 99214 99215 99401 99402 99406 G0444 G0447 | $149K |
| Dec 2023 | More hours than a day holds at a conservative unit price | 21.6 | 41.3 | 27.5 | 40.6 | 1348 | 1 | 99204 99213 99214 99215 99401 99406 G0396 G0444 G0447 | $139K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | PRITI JAIN, M.D. |
| Type | Individual |
| Status | Active |
| NPI issued | July 25, 2006, last updated November 27, 2019 |
| Practice location | 232 W OLD COUNTRY RD, Hicksville, NY 11801-4011, 516-938-1550 |
| Mailing address | 412 S BROADWAY, Hicksville, NY 11801-5009 |
| Specialties | Internal Medicine (207R00000X, primary, license 235381 NY) |
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 | $5.9M | 35% | $124 | $44 (top 5% from $110) | 96th percentile | |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $3.6M | 21% | $120 | $60 (top 5% from $133) | 93rd percentile | |
| 99204 | New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more | $1.9M | 11% | $112 | $95 (top 5% from $171) | 67th percentile | |
| 99203 | New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more | $1.8M | 11% | $99 | $67 (top 5% from $121) | 87th percentile | |
| S9083 | Medicaid service code | $1.3M | 7% | $172 | $113 (top 5% from $163) | 97th percentile | |
| U0003 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r | $850K | 5% | $67 | $75 (top 5% from $185) | 35th percentile | |
| 87426 | Detection test by immunoassay technique for severe acute respiratory syndrome coronavirus | $836K | 5% | $17 | $32 (top 5% from $49) | 18th percentile | |
| U0005 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within | $281K | 2% | $22 | $21 (top 5% from $38) | 54th percentile |
Medicare Part B 2024, largest codes
| code | what it is | services | beneficiaries | paid | submitted per service | allowed per service | charge to allowed | usual for this code |
|---|---|---|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | 107 | 95 | $10K | $294 | $139 | 2.1x | 2.3x (90th percentile 3.8x) |
| 99490 | Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month | 179 | 88 | $10K | $136 | $71 | 1.9x | 1.8x (90th percentile 2.9x) |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | 70 | 63 | $5K | $241 | $101 | 2.4x | 2.2x (90th percentile 3.8x) |
| 99204 | New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more | 26 | 26 | $3K | $358 | $185 | 1.9x | 2.4x (90th percentile 3.9x) |
| 87426 | Detection test by immunoassay technique for severe acute respiratory syndrome coronavirus | 54 | 49 | $2K | $105 | $35 | 3.0x | 2.8x (90th percentile 4.4x) |
| 87635 | Amplifed dna or rna probe detection of severe acute respiratory syndrome coronavirus 2 (covid-19) antigen | 33 | 29 | $2K | $133 | $50 | 2.6x | 2.4x (90th percentile 3.7x) |
| 99203 | New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more | 16 | 16 | $1K | $346 | $124 | 2.8x | 2.4x (90th percentile 3.9x) |
| G0442 | Annual alcohol misuse screening, 5 to 15 minutes | 42 | 41 | $893 | $51 | $21 | 2.4x | 2.2x (90th percentile 3.8x) |
A submitted charge many times the allowed amount is common and lawful; it matters when it is far above what other providers submit for the same code.
In this area
32 providers in Nassau County, NY carry an indicator in the public record, with $44.1M at stake between them. The most common is more hours than a day holds, on 26 of them, followed by paid after a public list action on 3. 3 are tier 1: documented action, then payment.
| tier | provider | at stake | why |
|---|---|---|---|
| 1 | ALEX BERGMANN Garden City, NY, ranked 352 | $3K |
|
| 1 | LAWRENCE HORL Rockville Centre, NY, ranked 383 | $1K |
|
| 1 | ROYA JAFARI-HASSAD Great Neck, NY, ranked 657 | $0 |
|
| 3 | EXTRAORDINARY HOME CARE Uniondale, NY, ranked 771 | $3.4M |
|
| 3 | MEADOWBROOK CARE CENTER, INC. Freeport, NY, ranked 4769 | $0 |
|
| 4 | FELIKS TABENSHLAK Merrick, NY, ranked 7389 | $8.2M |
|
| 4 | EMMANOUIL VASILAKIS Rockville Centre, NY, ranked 7498 | $3.9M |
|
| 4 | ARTHUR KAYE Floral Park, NY, ranked 7509 | $3.7M |
|
Recent enforcement in NY
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
DOJIndictedAug 20, 2026
Four Members Of The “War Room” Charged In Connection With $12 Million Medicaid Fraud Scheme
Members of a Bronx-based racketeering organization known as the "War Room" fabricated ride data for methadone clinic transportation using a GPS spoofing application, paid Medicaid patients kickbacks in cash and drugs for their enrollment information, provided the fake data to transportation companies that submitted over $12 million in claims to Medicaid, and laundered the proceeds.
DOJIndictedAug 20, 2026
Four Members of the “War Room” Charged in Connection with $12M Medicaid Fraud Scheme
Four members of a Bronx racketeering organization known as the "War Room" fabricated medical transportation ride data using a ride-tracking app and GPS spoofing, paid Medicaid patients at methadone clinics kickbacks in cash and drugs for their enrollment information, provided the fake data to transportation companies that submitted over $12 million in Medicaid claims, and laundered the proceeds.
DOJCivil settlementAug 17, 2026
Safire nursing homes agree to pay $9 million to resolve fraudulent Medicare and Medicaid billing allegations
The United States alleged that Safire submitted false claims to Medicare and Medicaid for skilled rehabilitative therapy services that were not reasonable or necessary, not supported by medical records, not documented as provided, or not provided at all, including by scheduling therapy based on insurer reimbursement policies, pressuring therapists and residents, and manufacturing or altering therapy referrals and medical records.
DOJSentencedJul 21, 2026
Owner of Long Island Ambulette Services Company Sentenced to Prison for Multimillion Dollar Healthcare Fraud Scheme
Arshad and co-conspirators paid kickbacks to Medicaid beneficiaries to order transportation through his companies and billed Medicaid over $19 million for medical transportation rides that were not provided, including for individuals who were deceased, hospitalized or incarcerated, and inflated reimbursements with false pickup addresses and distant treatment centers.
DOJIndictedJul 2, 2026
Two Defendants Charged with Multi-Million Dollar Health Care Fraud Scheme
The defendants, who owned and operated Tri-Hamlet Taxi Inc., allegedly paid kickbacks to Medicaid beneficiaries and submitted more than $35 million in claims to Medicaid for ambulette trips that were not provided or whose costs were inflated by using false pickup or drop-off addresses.
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.