Federally excluded VA-resident NPIs billing Medicare Part B (CY 2023)
LEIE exclusions bind across all federal programs (42 USC § 1320a-7). H30a joins the 125-NPI VA federally-excluded cohort against the CMS Medicare Physician & Other Practitioners by Provider file (CY 2023, NPI-aggregated). Any match is a direct federal compliance signal regardless of which state Medicaid program also paid them (see H29).
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 § 1320a-7 — pre-exclusion billing reflects work the provider was authorized to do at the time.
5 / 6.8K = 0.07%
unit: count
Null hypothesis
Zero currently-LEIE/SAM-excluded VA-resident NPIs appear as billing providers in the CMS Medicare Physician & Other Practitioners by Provider file for CY 2023.
Denominator
VA federally-excluded cohort (125 NPIs, active LEIE or SAM, score >= 1.5; VA-resident per NPPES practice state) joined against every NPI in the Medicare Part B by-Provider file.
Data source
CMS Medicare Physician & Other Practitioners — by Provider (MUP_PHY_R25_P05_V20_D23_Prov.csv, ~270 MB, NPI-aggregated CY 2023). See `analysis/claims_sources/medicare_partb.py`.
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 — same I/O cost as the original VA-only run.