Providers
RAKESH KUMAR SHAH, MD
NPI 1942419692, individual, Hopewell, VA, Psychiatry & Neurology, Child & Adolescent Psychiatry
4
Evidence tier
structure or single-organization volume
- Hours beyond a day in 4 months, but with up to 561 patients a month, which points to a supervising clinician on the claims rather than one person's hours.
- Records needed.
- Medicaid dollars per patient on code 99309 ($188 per patient-month) sit in the top 5% of every provider billing that code.
score 56 of 100, rank 7527, $3.4M 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 |
|---|---|---|---|---|---|---|---|---|---|
| May 2019 | More hours than a day holds at a conservative unit price | 18.4 | 36.3 | 24.2 | 32.6 | 548 | 1 | 90791 90792 99213 99223 99231 99232 99233 99238 99309 99310 | $46K |
| Jul 2019 | More hours than a day holds at a conservative unit price | 15.6 | 36.0 | 24.0 | 32.4 | 484 | 1 | 90791 90792 99213 99214 99223 99231 99232 99233 99238 99309 99310 | $45K |
| Aug 2023 | More hours than a day holds at a conservative unit price | 13.0 | 37.5 | 25.0 | 33.7 | 460 | 1 | 90792 99213 99223 99231 99232 99233 99238 99309 99310 | $56K |
| Jan 2024 | More hours than a day holds at a conservative unit price | 12.9 | 36.5 | 24.4 | 32.8 | 439 | 1 | 90792 99213 99223 99231 99232 99233 99238 99309 99310 | $56K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | RAKESH KUMAR SHAH, MD |
| Type | Individual |
| Status | Active |
| NPI issued | May 21, 2007, last updated October 10, 2013 |
| Practice location | 207 N 4TH AVE, Hopewell, VA 23860-2503, 804-541-0918 |
| Mailing address | 269 MEDICAL PARK BLVD, Petersburg, VA 23805-9337 |
| Specialties | Psychiatry & Neurology, Child & Adolescent Psychiatry (2084P0804X, primary, license 0101248223 VA) Psychiatry & Neurology, Psychiatry (2084P0800X, license 0101248223 VA) |
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 | |
|---|---|---|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | $935K | 27% | $61 | $44 (top 5% from $110) | 73rd percentile | |
| 99309 | Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes | $490K | 14% | $188 | $21 (top 5% from $84) | 99th percentile | |
| 90792 | Psychiatric diagnostic evaluation with medical services | $422K | 12% | $169 | $112 (top 5% from $313) | 78th percentile | |
| 99310 | Subsequent nursing facility care with high level of medical decision making, per day, if using time, at least 45 minutes | $413K | 12% | $149 | $30 (top 5% from $134) | 96th percentile | |
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | $247K | 7% | $92 | $67 (top 5% from $174) | 71st percentile | |
| 90791 | Psychiatric diagnostic evaluation | $246K | 7% | $140 | $105 (top 5% from $228) | 78th percentile | |
| 99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | $225K | 6% | $109 | $96 (top 5% from $249) | 59th percentile | |
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | $197K | 6% | $117 | $81 (top 5% from $170) | 79th 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 |
|---|---|---|---|---|---|---|---|---|
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | 158 | 51 | $9K | $200 | $73 | 2.7x | 2.6x (90th percentile 4.3x) |
| 99231 | Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes | 191 | 23 | $7K | $150 | $46 | 3.3x | 2.4x (90th percentile 4.0x) |
| 90792 | Psychiatric diagnostic evaluation with medical services | 44 | 39 | $5K | $325 | $161 | 2.0x | 2.2x (90th percentile 3.9x) |
| 99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | 49 | 23 | $4K | $250 | $111 | 2.3x | 2.6x (90th percentile 4.7x) |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | 23 | 11 | $2K | $175 | $119 | 1.5x | 2.3x (90th percentile 3.8x) |
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | 17 | 16 | $2K | $325 | $157 | 2.1x | 3.0x (90th percentile 5.6x) |
| 99238 | Hospital discharge day management, 30 minutes or less | 24 | 22 | $1K | $150 | $74 | 2.0x | 2.6x (90th percentile 4.7x) |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | 23 | 11 | $1K | $150 | $85 | 1.8x | 2.2x (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
8 providers in Prince George County, VA carry an indicator in the public record, with $18.1M at stake between them. The most common is more hours than a day holds, on 7 of them, followed by part of a provider network on 1.
| tier | provider | at stake | why |
|---|---|---|---|
| 3 | HOPEWELL HEALTH CARE LLC Hopewell, VA, ranked 3991 | $0 |
|
| 4 | THRESA SIMON Petersburg, VA, ranked 7491 | $4.0M |
|
| 4 | WALID FAWAZ Hopewell, VA, ranked 7516 | $3.6M |
|
| 4 | C. AMARA Petersburg, VA, ranked 7517 | $3.6M |
|
| 4 | SALMAN SIDDIQUI Hopewell, VA, ranked 7568 | $3.0M |
|
| 4 | MOHAMMAD IMTIAZ MUBBASHAR Petersburg, VA, ranked 9277 | $405K |
|
| 5 | DEVI VASU Petersburg, VA, ranked 9990 | $1.8M |
|
| 5 | ABDUL MOHIUDDIN Hopewell, VA, ranked 10853 | $1.7M |
Recent enforcement in VA
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
DOJChargedJun 23, 2026
U.S. Attorney’s Office announces charges against three defendants in the Eastern District of Virginia as part of national health care fraud takedown
Three defendants were charged with fraudulently billing Medicaid for mental health services that were not provided and with submitting false claims to Medicare through a straw-owned durable medical equipment company.
DOJSentencedJun 5, 2026
Medicaid service providers sentenced for false statements resulting in overbilling
Wright and Winfield instructed CCR employees to falsely claim in progress notes that children received therapeutic day treatment services from 2:00pm to 7:00pm, including providing prefilled progress note templates, resulting in overbilling to Medicaid.
DOJCivil settlementApr 27, 2026
Tri-Area Community Health Agrees to Pay $513,000 to Resolve Medicare Billing Allegations
Tri-Area Community Health billed Medicare for Annual Wellness Visits provided by pharmacists without appropriate physician supervision that were billed under the names of physicians not involved with the visits.
DOJSentencedMar 17, 2026
Six Sentenced in Healthcare Fraud Conspiracy that Stole $10 Million from Medicaid Over Six-Year Period
Six defendants conspired to submit false claims to Virginia Medicaid on behalf of 1st Adult N Pediatric Healthcare Services for nursing and personal care services that were not provided, including falsifying records and paying parents or guardians of patients for blank, signed nursing notes.
DOJIndictedMar 11, 2026
Victim Advisory- Divine Youth Case Updates
Divine Youth Counseling submitted more than $11 million in fraudulent Medicaid claims for Crisis Stabilization and Mobile Crisis services by falsely claiming two mental health professionals provided Team Treatment services and paid more than $470,000 in kickbacks in the form of hotel rooms for Medicaid recipients.
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.