{
  "slug": "excluded-billing-medicare-partb",
  "title": "Federally excluded NPIs billing Medicare Part B (CY 2023, all states)",
  "hypotheses": [
    "H30",
    "H30a"
  ],
  "status": "published",
  "release_date": "CY 2023 (RY2025 P05)",
  "generated_at": "2026-05-17T15:33:59+00:00",
  "methodology_version": "0.6.1-draft",
  "commit_sha": "334099e",
  "headline": "206 of 6,840 currently-active federally-excluded NPIs (across 52 state cohorts) billed Medicare Part B in CY 2023 (full-window total paid $30,770,165 on 635,144 services). Of those, **5 were billing STRICTLY POST-EXCLUSION** (LEIE or SAM exclusion-effective year before 2023), with $2,022,667 paid on 116,552 services. The strict-post-exclusion subset is the regulatorily significant signal under 42 USC \u00a7 1320a-7 \u2014 pre-exclusion billing reflects work the provider was authorized to do at the time.",
  "numerator": 5,
  "denominator": 6840,
  "numerator_full_window": 206,
  "numerator_note": "Numerator = NPIs billing Part B in CY 2023 with LEIE/SAM exclusion-effective year < 2023 (strict post-exclusion). Full-window numerator (any 2023 billing) = 206.",
  "denominator_note": "Federally-excluded cohort across all 52 state slices (6,840 unique NPIs; active LEIE or SAM; H23 score >= 1.5; state per NPPES practice state in the NDH practitioner table). Per-state CSVs at /api/v1/states/<state>/h30a-excluded-billing-partb.csv.",
  "data_source_release": "CY 2023 (RY2025 P05)",
  "data_source_url": "https://data.cms.gov/provider-summary-by-type-of-service/medicare-physician-other-practitioners",
  "chart": {
    "type": "bar",
    "unit": "count",
    "data": [
      {
        "label": "All federally-excluded NPIs billing Part B (full-window)",
        "value": 206
      },
      {
        "label": "Strictly post-exclusion subset",
        "value": 5
      }
    ]
  },
  "per_state": [
    {
      "state": "CA",
      "matches_full_window": 30,
      "matches_strict_post": 0,
      "paid_full_window": 3939979.2,
      "paid_strict_post": 0
    },
    {
      "state": "NY",
      "matches_full_window": 17,
      "matches_strict_post": 0,
      "paid_full_window": 6142397.68,
      "paid_strict_post": 0
    },
    {
      "state": "FL",
      "matches_full_window": 12,
      "matches_strict_post": 0,
      "paid_full_window": 905258.66,
      "paid_strict_post": 0
    },
    {
      "state": "TX",
      "matches_full_window": 12,
      "matches_strict_post": 1,
      "paid_full_window": 4694281.77,
      "paid_strict_post": 1862190.5
    },
    {
      "state": "PA",
      "matches_full_window": 11,
      "matches_strict_post": 1,
      "paid_full_window": 1067545.26,
      "paid_strict_post": 14699.59
    },
    {
      "state": "MO",
      "matches_full_window": 8,
      "matches_strict_post": 0,
      "paid_full_window": 2866584.07,
      "paid_strict_post": 0
    },
    {
      "state": "NJ",
      "matches_full_window": 8,
      "matches_strict_post": 1,
      "paid_full_window": 389927.79,
      "paid_strict_post": 122698.62
    },
    {
      "state": "VA",
      "matches_full_window": 8,
      "matches_strict_post": 0,
      "paid_full_window": 337190.78,
      "paid_strict_post": 0
    },
    {
      "state": "IL",
      "matches_full_window": 7,
      "matches_strict_post": 0,
      "paid_full_window": 390689.13,
      "paid_strict_post": 0
    },
    {
      "state": "TN",
      "matches_full_window": 7,
      "matches_strict_post": 0,
      "paid_full_window": 99396.16,
      "paid_strict_post": 0
    },
    {
      "state": "OH",
      "matches_full_window": 6,
      "matches_strict_post": 1,
      "paid_full_window": 58490.23,
      "paid_strict_post": 4928.59
    },
    {
      "state": "GA",
      "matches_full_window": 6,
      "matches_strict_post": 0,
      "paid_full_window": 480753.63,
      "paid_strict_post": 0
    },
    {
      "state": "MS",
      "matches_full_window": 6,
      "matches_strict_post": 0,
      "paid_full_window": 36583.21,
      "paid_strict_post": 0
    },
    {
      "state": "NC",
      "matches_full_window": 5,
      "matches_strict_post": 0,
      "paid_full_window": 637630.4,
      "paid_strict_post": 0
    },
    {
      "state": "MI",
      "matches_full_window": 5,
      "matches_strict_post": 0,
      "paid_full_window": 278622.82,
      "paid_strict_post": 0
    },
    {
      "state": "LA",
      "matches_full_window": 4,
      "matches_strict_post": 0,
      "paid_full_window": 65879.22,
      "paid_strict_post": 0
    },
    {
      "state": "OK",
      "matches_full_window": 4,
      "matches_strict_post": 0,
      "paid_full_window": 4922833.27,
      "paid_strict_post": 0
    },
    {
      "state": "KY",
      "matches_full_window": 4,
      "matches_strict_post": 0,
      "paid_full_window": 352672.48,
      "paid_strict_post": 0
    },
    {
      "state": "AZ",
      "matches_full_window": 3,
      "matches_strict_post": 0,
      "paid_full_window": 574061.21,
      "paid_strict_post": 0
    },
    {
      "state": "OR",
      "matches_full_window": 3,
      "matches_strict_post": 0,
      "paid_full_window": 69673.72,
      "paid_strict_post": 0
    },
    {
      "state": "IA",
      "matches_full_window": 3,
      "matches_strict_post": 0,
      "paid_full_window": 143506.98,
      "paid_strict_post": 0
    },
    {
      "state": "AL",
      "matches_full_window": 3,
      "matches_strict_post": 0,
      "paid_full_window": 15022.94,
      "paid_strict_post": 0
    },
    {
      "state": "WI",
      "matches_full_window": 3,
      "matches_strict_post": 0,
      "paid_full_window": 67486.16,
      "paid_strict_post": 0
    },
    {
      "state": "CT",
      "matches_full_window": 2,
      "matches_strict_post": 0,
      "paid_full_window": 51057.84,
      "paid_strict_post": 0
    },
    {
      "state": "KS",
      "matches_full_window": 2,
      "matches_strict_post": 0,
      "paid_full_window": 10888.89,
      "paid_strict_post": 0
    },
    {
      "state": "ME",
      "matches_full_window": 2,
      "matches_strict_post": 0,
      "paid_full_window": 30630.38,
      "paid_strict_post": 0
    },
    {
      "state": "PR",
      "matches_full_window": 2,
      "matches_strict_post": 0,
      "paid_full_window": 4843.49,
      "paid_strict_post": 0
    },
    {
      "state": "CO",
      "matches_full_window": 2,
      "matches_strict_post": 0,
      "paid_full_window": 59565.32,
      "paid_strict_post": 0
    },
    {
      "state": "WA",
      "matches_full_window": 2,
      "matches_strict_post": 0,
      "paid_full_window": 9722.23,
      "paid_strict_post": 0
    },
    {
      "state": "MD",
      "matches_full_window": 2,
      "matches_strict_post": 0,
      "paid_full_window": 121738.23,
      "paid_strict_post": 0
    },
    {
      "state": "MA",
      "matches_full_window": 2,
      "matches_strict_post": 0,
      "paid_full_window": 30871.36,
      "paid_strict_post": 0
    },
    {
      "state": "AR",
      "matches_full_window": 2,
      "matches_strict_post": 0,
      "paid_full_window": 125383.8,
      "paid_strict_post": 0
    },
    {
      "state": "NV",
      "matches_full_window": 2,
      "matches_strict_post": 0,
      "paid_full_window": 701128.54,
      "paid_strict_post": 0
    },
    {
      "state": "SC",
      "matches_full_window": 2,
      "matches_strict_post": 0,
      "paid_full_window": 33953.36,
      "paid_strict_post": 0
    },
    {
      "state": "UT",
      "matches_full_window": 1,
      "matches_strict_post": 0,
      "paid_full_window": 5156.28,
      "paid_strict_post": 0
    },
    {
      "state": "ID",
      "matches_full_window": 1,
      "matches_strict_post": 0,
      "paid_full_window": 4630.55,
      "paid_strict_post": 0
    },
    {
      "state": "NE",
      "matches_full_window": 1,
      "matches_strict_post": 0,
      "paid_full_window": 1379.06,
      "paid_strict_post": 0
    },
    {
      "state": "MN",
      "matches_full_window": 1,
      "matches_strict_post": 0,
      "paid_full_window": 2735.47,
      "paid_strict_post": 0
    },
    {
      "state": "WV",
      "matches_full_window": 1,
      "matches_strict_post": 0,
      "paid_full_window": 21000.37,
      "paid_strict_post": 0
    },
    {
      "state": "DE",
      "matches_full_window": 1,
      "matches_strict_post": 0,
      "paid_full_window": 802864.88,
      "paid_strict_post": 0
    },
    {
      "state": "IN",
      "matches_full_window": 1,
      "matches_strict_post": 0,
      "paid_full_window": 195249.83,
      "paid_strict_post": 0
    },
    {
      "state": "NM",
      "matches_full_window": 1,
      "matches_strict_post": 0,
      "paid_full_window": 2748.72,
      "paid_strict_post": 0
    },
    {
      "state": "RI",
      "matches_full_window": 1,
      "matches_strict_post": 1,
      "paid_full_window": 18149.32,
      "paid_strict_post": 18149.32
    }
  ],
  "notes": "Per-state CSV at /api/v1/states/<state>/h30a-excluded-billing-partb.csv carries one row per matched NPI with paid + allowed + services + beneficiaries + provider type + exclusion source + post-exclusion flag. Source CSV streamed once and partitioned across all state cohorts in memory \u2014 same I/O cost as the original VA-only run."
}