DAVID NATHANIEL SMITH, MD

Evidence tier 1: documented action, then payment. Dollars at stake are $1,063,751, taken from the detector that set the tier. Listed on the Medicare revocation list and the SC Medicaid exclusion list since August 30, 2021. Medicaid still paid claims in 7 later months, $1,063,751 in total. Medicaid dollars per patient on code 80307 ($557 per patient-month) sit in the top 5% of every provider billing that code. Medicare revoked billing privileges on August 30, 2021 under 42 CFR 424.535(a)(1) noncompliance (not professionally licensed) and 424.535(a)(9) failure to report.

1. 01Evidence tier 1: documented action, then payment. Dollars at stake are $1,063,751, taken from the detector that set the tier. records 2
2. 02Listed on the Medicare revocation list and the SC Medicaid exclusion list since August 30, 2021. records 3
3. 03Medicaid still paid claims in 7 later months, $1,063,751 in total. records 4
4. 04Medicaid dollars per patient on code 80307 ($557 per patient-month) sit in the top 5% of every provider billing that code. records 5
5. 05Medicare revoked billing privileges on August 30, 2021 under 42 CFR 424.535(a)(1) noncompliance (not professionally licensed) and 424.535(a)(9) failure to report. The bar on re-enrolling runs to October 21, 2027. records 6
6. 06The Medicare revocation list action is dated August 30, 2021. Medicaid then paid $1,063,751 across 7 later months, from September 2021 to December 2022. The screening window closes on October 21, 2027. In the 12 months before the action Medicaid paid $2,674,933. records 7
7. 07The SC Medicaid exclusion list action is dated November 16, 2022. Medicaid then paid $23,337 across 1 later month, from December 2022 to December 2022. In the 12 months before the action Medicaid paid $246,274. records 8
8. 08Code G0483, Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms, was paid $2,912,337 over 24 months. That is 68% of this provider's Medicaid dollars. It runs at $557 per patient-month. That ranks at the 99th percentile of all providers billing this code, where the typical figure is $146. records 9
9. 09Code 80307, Testing for presence of drug, by chemistry analyzers, was paid $1,079,222 over 24 months. That is 25% of this provider's Medicaid dollars. It runs at $206 per patient-month. That ranks at the 99th percentile of all providers billing this code, where the typical figure is $45. records 10
10. 10Code 99213, Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more, was paid $70,293 over 14 months. That is 2% of this provider's Medicaid dollars. It runs at $115 per patient-month. That ranks at the 96th percentile of all providers billing this code, where the typical figure is $44. records 11
11. 11Code 99214, Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more, was paid $57,525 over 26 months. That is 1% of this provider's Medicaid dollars. It runs at $71 per patient-month. That ranks at the 62nd percentile of all providers billing this code, where the typical figure is $60. records 12
12. 12Code 99215, Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more, was paid $46,306 over 5 months. That is 1% of this provider's Medicaid dollars. It runs at $186 per patient-month. This code family has a history of abuse. records 13
13. 13Code 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, was paid $42,000 over 6 months. That is 1% of this provider's Medicaid dollars. It runs at $128 per patient-month. That ranks at the 89th percentile of all providers billing this code, where the typical figure is $75. records 14

Route to the health plan special investigations unit, and to the state Medicaid program integrity unit where the payer is a Medicaid managed care plan, for a records request and a screening check under 42 CFR 455.436. Consider a pre-payment review pending that check; a payment suspension under 42 CFR 455.23 requires the state's own credible-allegation determination. Verify every fact against the cited rows before any action. This packet is a screening product, not a finding.

• A revocation can be reversed on appeal or through a corrective action plan; confirm the current enrollment status with the state and in PECOS before acting.
• State lists carry reinstatements and administrative terminations; confirm the action type with the listing agency.