Providers
All 16 in KY
MATTHEW JOHN PIERZALA, D.O.
NPI 1811931389, individual, Louisa, KY, Internal Medicine
4
Evidence tier
structure or single-organization volume
- Hours beyond a day in 9 months, but with up to 1650 patients a month, which points to a supervising clinician on the claims rather than one person's hours.
- Records needed.
score 51 of 100, rank 8667, $2.3M 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.
| 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 |
|---|---|---|---|---|---|---|---|---|---|
| Aug 2023 | More hours than a day holds, even counting one unit per claim line | 25.8 | 33.5 | 22.3 | 30.1 | 1650 | 1 | 99211 99214 | $156K |
| Sep 2023 | More hours than a day holds, even counting one unit per claim line | 24.3 | 31.4 | 20.9 | 29.9 | 1592 | 1 | 99211 99214 | $142K |
| Oct 2023 | More hours than a day holds, even counting one unit per claim line | 24.0 | 30.8 | 20.6 | 29.0 | 1626 | 1 | 99211 99214 | $144K |
| Nov 2023 | More hours than a day holds, even counting one unit per claim line | 25.3 | 32.0 | 21.3 | 29.1 | 1606 | 1 | 99211 99214 | $144K |
| Feb 2024 | More hours than a day holds, even counting one unit per claim line | 31.9 | 30.1 | 20.1 | 27.7 | 1525 | 1 | 99211 | $131K |
| Mar 2024 | More hours than a day holds, even counting one unit per claim line | 27.2 | 29.1 | 19.4 | 28.6 | 1507 | 1 | 99211 | $135K |
| Apr 2024 | More hours than a day holds, even counting one unit per claim line | 29.9 | 30.5 | 20.4 | 27.8 | 1531 | 1 | 99204 99211 | $137K |
| May 2024 | More hours than a day holds, even counting one unit per claim line | 30.9 | 29.8 | 19.8 | 26.7 | 1517 | 1 | 99211 99214 | $138K |
| Jun 2024 | More hours than a day holds, even counting one unit per claim line | 24.2 | 27.3 | 18.2 | 27.3 | 1507 | 1 | 99211 99214 | $123K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | MATTHEW JOHN PIERZALA, D.O. |
| Type | Individual |
| Status | Active |
| NPI issued | June 15, 2006, last updated December 4, 2025 |
| Practice location | 203 S WATER ST, Louisa, KY 41230-1347, 606-649-2211 |
| Mailing address | PO BOX 726, Louisa, KY 41230-0726 |
| Specialties | Internal Medicine (207R00000X, license 3522 WV) Neuromusculoskeletal Medicine, Sports Medicine (204C00000X, license ky02941 KY) Specialist (174400000X) Internal Medicine (207R00000X, primary, license KY02941 KY) |
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 | |
|---|---|---|---|---|---|---|---|
| 99211 | Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional | $2.7M | 50% | $74 | $16 (top 5% from $128) | 89th percentile | |
| 80307 | Testing for presence of drug, by chemistry analyzers | $1.6M | 30% | $87 | $45 (top 5% from $110) | 89th percentile | |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | $233K | 4% | $46 | $44 (top 5% from $110) | 53rd percentile | |
| 99484 | Care management services for behavioral health conditions, 20 minutes or more clinical staff time directed by health care professional | $154K | 3% | $29 | $5.77 (top 5% from $314) | 89th percentile | |
| 87426 | Detection test by immunoassay technique for severe acute respiratory syndrome coronavirus | $151K | 3% | $24 | $32 (top 5% from $49) | 29th percentile | |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $121K | 2% | $72 | $60 (top 5% from $133) | 63rd percentile | |
| G0480 | 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 | $84K | 2% | $94 | $58 (top 5% from $129) | too few months to rank | |
| 80305 | Testing for presence of drug, read by direct observation | $82K | 2% | $9.92 | $9.23 (top 5% from $22) | 55th percentile |
In this area
16 providers in Lawrence County, KY carry an indicator in the public record, with $70.5M at stake between them. The most common is more hours than a day holds, on 12 of them, followed by named in an enforcement record on 3. 3 are tier 1: documented action, then payment.
| tier | provider | at stake | why |
|---|---|---|---|
| 1 | PIONEER HEALTH GROUP LLC Louisa, KY, ranked 47 | $2.9M |
|
| 1 | PIONEER HEALTH GROUP LLC Louisa, KY, ranked 474 | $0 |
|
| 1 | PIONEER HEALTH GROUP LLC Louisa, KY, ranked 639 | $0 |
|
| 3 | MCKENZIE HEALTH CARE, LLC Louisa, KY, ranked 3271 | $0 |
|
| 4 | SARA MARTIN Louisa, KY, ranked 9205 | $514K |
|
| 5 | SARAH CAMPBELL Louisa, KY, ranked 9886 | $5.6M |
|
| 5 | TRACEY JOHNSON Louisa, KY, ranked 10640 | $15.6M | |
| 5 | JESSICA RIDDLE Louisa, KY, ranked 10648 | $13.0M |
Recent enforcement in KY
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
DOJIndictedAug 27, 2026
Kentucky Medical Biller Indicted for Healthcare Fraud and Money Laundering Charges
Sanders recruited individuals to open behavioral health entities, handled their Kentucky Medicaid credentialing and enrollment, and directed submission of fraudulent Medicaid claims across ten behavioral health providers for services never provided, including for incarcerated, hospitalized, or deceased members, using licensed professionals' NPIs without authorization.
DOJChargedJun 23, 2026
5 Individuals and 2 Companies Charged as Part of Department of Justice National Health Care Fraud Takedown
Seven defendants were charged in four cases with schemes including billing Kentucky Medicaid for peer support and psychoeducation services that were fraudulent, unauthorized, or not rendered using providers' NPIs, using a DEA number to order controlled substances in others' names, credentialing a company with Medicare and billing for services not rendered using a doctor's NPI, and stealing controlled substances from hospitals and falsely documenting administration.
DOJCivil settlementJun 23, 2026
Civil Settlements Reached as Part of Department of Justice National Health Care Fraud Takedown
Three Home and Community Based Waiver providers and their owners, who had shared financial interests, referred Medicaid waiver beneficiaries for attendant care services and billed Medicaid for attendant care hours that were not fully provided or not provided at all.
DOJCivil judgmentMay 15, 2026
Operators of Day Treatment Program for Children Agree to $15.2 Million Civil Judgment to Resolve Medicaid Fraud Allegations
The Government alleged that from August 2022 through June 2025 the Recovery Centers sought Medicaid payments for time children spent on education, recreation, and lunch breaks at the Aspire Day Program and that Recovery Center of Kentucky falsely represented clinician qualifications to obtain higher reimbursements.
DOJSentencedApr 24, 2026
Former Sober Home Owner and Operator Sentenced for Kickback Conspiracy and Health Care Fraud
Jordan solicited and received kickbacks in exchange for referring urine drug testing from her sober home company to three labs, and Serenity Keepers billed Medicaid for peer support services not provided by licensed peer support specialists, with Williams reporting that residents received six hours of peer support services per day knowing that was not true.
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.