Providers
DEREK WILLIAM RATLIFF, APRN, PMHNP
NPI 1861094211, individual, Paducah, KY, Nurse Practitioner, Psych/Mental Health
4
Evidence tier
structure or single-organization volume
- Hours beyond a day in 3 months, but with up to 1162 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 9317, $349K 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 |
|---|---|---|---|---|---|---|---|---|---|
| Sep 2021 | More hours than a day holds, even counting one unit per claim line | 37.1 | 37.1 | 24.7 | 33.7 | 822 | 2 | 90791 90832 90833 90834 90837 99205 99214 | $81K |
| Oct 2021 | More hours than a day holds, even counting one unit per claim line | 35.7 | 34.6 | 23.1 | 34.1 | 902 | 2 | 90791 90832 90833 90834 90837 90847 99204 99213 99214 | $78K |
| Nov 2021 | More hours than a day holds, even counting one unit per claim line | 45.8 | 48.5 | 32.3 | 44.1 | 1162 | 2 | 90791 90833 90834 90837 99204 99213 99214 | $106K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | DEREK WILLIAM RATLIFF, APRN, PMHNP |
| Type | Individual |
| Status | Active |
| NPI issued | November 11, 2020, last updated February 15, 2024 |
| Practice location | 425 BROADWAY ST STE 101, Paducah, KY 42001-0713, 270-442-7121 |
| Mailing address | 425 BROADWAY ST, Paducah, KY 42001-0713 |
| Specialties | Nurse Practitioner, Psych/Mental Health (363LP0808X, primary, license 3015461 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 | |
|---|---|---|---|---|---|---|---|
| 90837 | Psychotherapy, 1 hourhistory of abuse | $242K | 26% | $130 | $191 (top 5% from $442) | 22nd percentile | |
| H0031 | Medicaid service code | $152K | 16% | $111 | $100 (top 5% from $540) | 55th percentile | |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $102K | 11% | $54 | $60 (top 5% from $133) | 42nd percentile | |
| H0002 | Medicaid service code | $65K | 7% | $107 | $34 (top 5% from $215) | 84th percentile | |
| H2020 | Therapeutic behavioral services per diem | $65K | 7% | $782 | $455 (top 5% from $2K) | too few months to rank | |
| 90887 | Medicaid service code | $54K | 6% | $70 | $98 (top 5% from $270) | 30th percentile | |
| 90791 | Psychiatric diagnostic evaluation | $43K | 5% | $85 | $105 (top 5% from $228) | too few months to rank | |
| T2023 | Medicaid service code | $42K | 5% | $420 | $332 (top 5% from $1K) | 74th 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 | 97 | 40 | $5K | $147 | $77 | 1.9x | 2.3x (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
7 providers in McCracken County, KY carry an indicator in the public record, with $8.8M at stake between them. The most common is more hours than a day holds, on 5 of them, followed by part of a provider network on 2.
| tier | provider | at stake | why |
|---|---|---|---|
| 3 | BAPTIST HEALTH HOME CARE KY LLC Paducah, KY, ranked 2409 | $0 |
|
| 3 | PROVIDENCE POINT HEALTHCARE, INC. Paducah, KY, ranked 5958 | $0 |
|
| 4 | LAURIE BALLEW Paducah, KY, ranked 7655 | $2.3M |
|
| 4 | SHELLY BAER Paducah, KY, ranked 8478 | $3.8M |
|
| 4 | GRETCHEN ROOF Paducah, KY, ranked 8664 | $2.3M |
|
| 4 | SAMANTHA JONES Paducah, KY, ranked 9288 | $387K |
|
| 5 | DANIEL SUSSMAN Paducah, KY, ranked 11593 | $124K |
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.