FAY SMITH

NPI 1942679030, individual, Martinsburg, WV, Social Worker

Evidence tier

structure or single-organization volume

Hours beyond a day in 2 months under one organization, which can be supervisory billing.
Records needed.

score 51 of 100, rank 9202, $517K 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
Apr 2018	More hours than a day holds at a conservative unit price	14.2	50.9	33.9	48.5	411	1	90832 90834 90853	$121K
May 2018	More hours than a day holds at a conservative unit price	16.6	55.9	37.2	50.2	477	1	90832 90834 90853	$137K

National provider registry

From the CMS NPPES Registry, refreshed daily.

Name	FAY SMITH
Type	Individual
Status	Active
NPI issued	September 18, 2015, last updated May 7, 2021
Practice location	37 VICTORIA DR., Martinsburg, WV 25404, 304-681-2180
Specialties	Social Worker (104100000X, license APOO454008 WV) Social Worker (104100000X, primary, license APE0454008 WV)

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
90832	Psychotherapy, 30 minutes	$298K	50%	$369	$59 (top 5% from $239)	99th percentile
90834	Psychotherapy, 45 minutes	$235K	39%	$310	$101 (top 5% from $318)	95th percentile
90853	Group psychotherapyhistory of abuse	$42K	7%	$52	$60 (top 5% from $332)	44th percentile
90837	Psychotherapy, 1 hourhistory of abuse	$22K	4%	$139	$191 (top 5% from $442)	26th percentile
90791	Psychiatric diagnostic evaluation	$3K	0%	$113	$105 (top 5% from $228)	too few months to rank

In this area

47 providers in WV carry an indicator in the public record, with $22.1M at stake between them. The most common is more hours than a day holds, on 33 of them, followed by part of a provider network on 6. 6 are tier 1: documented action, then payment.

tier	provider	at stake	why
1	JOSEPH JURAND Martinsburg, WV, ranked 194	$48K	Listed on the MD Medicaid exclusion list since September 11, 2015. Medicaid still paid claims in 8 later months, $47,640 in total.
1	MICHAEL SHRAMOWIAT LLC Vienna, WV, ranked 202	$43K	Listed on the Medicare revocation list since November 19, 2014. Medicaid still paid claims in 21 later months, $42,976 in total.
1	SHAWN BLANKENSHIP Charleston, WV, ranked 289	$0	Adjudicated (pleaded guilty) per a state attorney general release dated March 20, 2025. No Medicaid payments in the last 12 observed months. and 4 more
1	HUGH SMITH Charleston, WV, ranked 314	$6K	Listed on the Medicare revocation list since January 7, 2021. Medicaid still paid claims in 5 later months, $6,083 in total.
1	WILLIAM EARLEY Vienna, WV, ranked 428	$265	Listed on the SC Medicaid exclusion list since May 1, 2018. Medicaid still paid claims in 1 later month, $265 in total.
1	HOLISTIC, INC Charleston, WV, ranked 557	$0	Adjudicated (pleaded guilty) per a state attorney general release dated March 20, 2025. No Medicaid payments in the last 12 observed months.
3	BRIAN MCDEVITT Chapmanville, WV, ranked 1665	$915	Charged (indicted) per a Department of Justice release dated June 27, 2024, not adjudicated. Medicaid paid $915 in the last 12 observed months.
3	HARRELL NURSING HOME Charleston, WV, ranked 2693	$0	Part of provider network D1-00115, ranked 115 nationally.

All 47 in WV

Recent enforcement in WV

All releases

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

DOJCivil settlementJun 23, 2026

Northern District of West Virginia Part of National Health Care Fraud Takedown Resulting in 455 Defendants Charged in Connection with Over $6.5 Billion in Alleged Fraud

Two providers reached civil settlements resolving allegations that they used pre-signed, invalid prescriptions issued outside the usual course of their professional practice to patients in West Virginia while traveling and not in close proximity to their offices, and in one case submitted claims to Medicare and Medicaid during that time.

DOJComplaint filedJun 23, 2026

U.S. Attorney Moore Capito Announces Fraud Conspiracy Charges Against Sober Living Home Founder and Spouse

Two individuals affiliated with a sober living recovery program allegedly conspired to falsify and submit timesheets to a testing laboratory for drug testing work not performed, and the laboratory paid the billings and obtained reimbursement from federal and state healthcare programs; separately, a sleep laboratory paid $120,000 to resolve allegations it billed Medicaid and the VA Community Health program for sleep studies and polysomnogram reports prepared and signed by unqualified, non-physician staff.

DOJPleaded guiltyJun 17, 2026

Mercer County Woman Pleads Guilty to $175,731.31 Fraud Scheme Targeting Federal Veterans Health Care Benefits

Radford, an owner of Healthcare Therapy Services LLC doing business as Medical Massage Therapy, submitted false bills to CHAMPVA for massage services not rendered, stealing $175,731.31.

DOJCivil settlementMar 5, 2026

Laboratory Agrees to Pay More than $200,000 for Improper Billing to West Virginia Medicaid Program

Integra repeatedly submitted billings to the West Virginia Medicaid program for medically unnecessary testing ordered by medical providers over a two-year period, specifically improper claims for specimen validity testing that were not allowable.

DOJCivil settlementApr 2, 2025

Beckley Medical Clinic and Physician Agree to Pay $152,382.70 to Resolve False Claims Act Allegations

Med-Surg and its owner submitted claims to Medicare and Medicaid using HCPCS code Q3014 for the telehealth originating site facility fee for telehealth visits where the patient was at home, which is not payable.

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.

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