MAI LE PROVENCIO, LCSW

NPI 1821534017, individual, Boise, ID, Social Worker, Clinical

Evidence tier

informational

Medicaid dollars per patient on code T1013 ($381 per patient-month) sit in the top 5% of every provider billing that code.

score 35 of 100, rank 9988, $1.8M at stake

National provider registry

From the CMS NPPES Registry, refreshed daily.

Name	MAI LE PROVENCIO, LCSW
Type	Individual, sole proprietor
Status	Active
NPI issued	January 11, 2017, last updated October 23, 2024
Practice location	7235 W POTOMAC DR STE 220, Boise, ID 83704-9133, 208-794-9703
Specialties	Social Worker, Clinical (1041C0700X, primary, license LCSW-34323 ID)

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
T1013	Sign language or oral interpretive services per 15 min	$929K	39%	$381	$20 (top 5% from $260)	97th percentile
H0038	Self-help/peer services per 15 min	$898K	37%	$456	$147 (top 5% from $2K)	80th percentile
90834	Psychotherapy, 45 minutes	$526K	22%	$334	$101 (top 5% from $318)	96th percentile
H2017	Psychosocial rehabilitation services per 15 minhistory of abuse	$34K	1%	$386	$310 (top 5% from $1K)	too few months to rank
90791	Psychiatric diagnostic evaluation	$9K	0%	$135	$105 (top 5% from $228)	too few months to rank
H0032	Medicaid service code	$9K	0%	$89	$98 (top 5% from $675)	46th percentile

In this area

10 providers in Ada County, ID carry an indicator in the public record, with $11.2M 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	LIGHTHOUSE HOSPICE LLC Meridian, ID, ranked 2269	$0	Part of provider network D1-00023, ranked 23 nationally.
3	FIRST CHOICE HOME CARE, INC. Boise, ID, ranked 4162	$0	Part of provider network D1-00077, ranked 77 nationally.
3	A BETTER WAY HOME, LLC Boise, ID, ranked 5407	$0	Part of provider network D1-00077, ranked 77 nationally.
4	ZACHARIAH JENSEN Boise, ID, ranked 9412	$252K	Hours beyond a day in 2 months under one organization, which can be supervisory billing. Records needed.
5	BRIAN RAYMOND Star, ID, ranked 9899	$4.5M	Medicaid dollars per patient on code T1013 ($549 per patient-month) sit in the top 5% of every provider billing that code.
5	TYE KILLIAN Boise, ID, ranked 9957	$2.2M	Medicaid dollars per patient on code T1013 ($426 per patient-month) sit in the top 5% of every provider billing that code.
5	TAMI JONES Boise, ID, ranked 10034	$1.5M	Medicaid dollars per patient on code T1013 ($369 per patient-month) sit in the top 5% of every provider billing that code.
5	ROSALIE LYNCH Eagle, ID, ranked 10128	$909K	Medicaid dollars per patient on code T1013 ($523 per patient-month) sit in the top 5% of every provider billing that code.

All 10 in ID

Recent enforcement in ID

All releases

Department of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.

DOJCivil settlementOct 29, 2024

Boise Health Care Company and Former Therapist Resolve Fraudulent Psychotherapy Billing Allegations Involving Vulnerable Refugee Population

KA Health Services and its owner paid $321,576.51 to resolve allegations they submitted false Medicaid claims for psychotherapy, language interpretation, and other services that were never provided or not provided by a qualified professional, and a former counselor consented to a $40,000 judgment after admitting she directed unqualified interpreters to meet with refugee clients and signed false medical records.

DOJCivil settlementApr 3, 2024

Pocatello Doctor Pays $96,000 to Settle Allegations That He Wrote Unlawful Prescriptions

The government alleged that Knouf wrote prescriptions for controlled substances that lacked a legitimate medical purpose and/or were issued outside the usual course of professional practice, prescribed dangerous combinations of drugs, and billed Medicare and Medicaid for services that were not performed.

DOJCivil judgmentJan 17, 2024

AmeriHealth Clinics Consent to a $2 Million Judgment to Resolve Healthcare Fraud Allegations

AmeriHealth and its owners hired vulnerable, compromised, and inexperienced medical staff who were pressured into providing unnecessary and worthless care, resulting in false claims to federal health care programs, and also allegedly pressured practitioners to prescribe controlled substances, entered a kickback scheme with a third-party laboratory, and falsely certified information to obtain PPP loan forgiveness.

Referral packet

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