LISA ANN UTSEY, M.D.
NPI 1932282803, individual, Haines City, FL, Pediatrics
- Hours beyond a day in 1 month, but with up to 852 patients a month, which points to a supervising clinician on the claims rather than one person's hours.
- Records needed.
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 2022 | More hours than a day holds at a conservative unit price | 12.1 | 36.8 | 24.5 | 33.4 | 852 | 1 | 99213 99214 | $91K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | LISA ANN UTSEY, M.D. |
| Type | Individual |
| Status | Active |
| NPI issued | October 23, 2006, last updated January 12, 2015 |
| Practice location | 900 INGRAHAM AVE, Haines City, FL 33844-4336, 863-421-6565 |
| Specialties | Pediatrics (208000000X, primary, license ME72026 FL) |
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.
| 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 | $2.4M | 36% | $96 | $44 (top 5% from $110) | 93rd percentile | |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $1.1M | 17% | $125 | $60 (top 5% from $133) | 94th percentile | |
| 90460 | Administration of first vaccine or toxoid component with counseling (18 years or younger) | $546K | 8% | $41 | $26 (top 5% from $54) | 79th percentile | |
| 99393 | Medicaid service code | $486K | 7% | $103 | $78 (top 5% from $121) | 86th percentile | |
| 99392 | Medicaid service code | $421K | 6% | $104 | $78 (top 5% from $124) | 87th percentile | |
| 99394 | Medicaid service code | $414K | 6% | $108 | $83 (top 5% from $128) | 82nd percentile | |
| 99391 | Medicaid service code | $295K | 4% | $99 | $76 (top 5% from $126) | 84th percentile | |
| 87804 | Detection test by immunoassay with direct visual observation for influenza virus | $226K | 3% | $24 | $22 (top 5% from $33) | 61st percentile |
In this area
18 providers in Polk County, FL carry an indicator in the public record, with $29.7M at stake between them. The most common is more hours than a day holds, on 13 of them, followed by part of a provider network on 5.
| tier | provider | at stake | why |
|---|---|---|---|
| 3 | GOOD SHEPHERD HOSPICE, INC. Lakeland, FL, ranked 1417 | $52K |
|
| 3 | EMPATH HOSPICE, LLC Lakeland, FL, ranked 2612 | $0 |
|
| 3 | PINNACLE HOME CARE OF HILLSBOROUGH, LLC. Winter Haven, FL, ranked 2896 | $0 |
|
| 3 | CENTERWELL HEALTH SERVICES (CERTIFIED), INC. Lakeland, FL, ranked 4023 | $0 |
|
| 3 | LAKELAND HOME CARE SERVICES, LLC Winter Haven, FL, ranked 6573 | $0 |
|
| 4 | RAJESWARI SONNI Lake Wales, FL, ranked 8346 | $6.8M |
|
| 4 | PARMJIT GILL Lakeland, FL, ranked 8480 | $3.7M |
|
| 4 | PHIMAGHAM PREMKANTH Bartow, FL, ranked 8488 | $3.6M |
|
Recent enforcement in FL
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
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.