Claims Paid by Medicare to Adarna

For Conrado Castor's Home Health Care Referrals

For the period July 22, 2008 through January 13, 2014

Exhibit 1 D

Page 1 of 2

Claim Claim Number Claim 

From Date

Claim To 

Date

Claim 

Reimbursem

ent

1 20827703402605 02 7/22/2008 9/19/2008 $2,276.50 

2 20834404587205 02 9/10/2008 11/8/2008 $4,725.86 

3 20834404586805 02 9/20/2008 11/18/2008 $1,579.79 

4 20903304505405 02 10/31/2008 12/29/2008 $3,621.46 

5 20903304504605 02 11/9/2008 1/7/2009 $3,631.70 

6 20905000788205 02 11/19/2008 12/31/2008 $1,410.74 

7 20910302818805INR 02 12/30/2008 2/27/2009 $3,631.70 

8 20908500112205 02 1/8/2009 3/2/2009 $2,883.57 

9 20915223388005INRT 02 1/20/2009 2/22/2009 $2,265.31 

10 20911801213705INR 02 2/11/2009 4/11/2009 $1,701.34 

11 20914604115905INR 02 2/28/2009 4/27/2009 $3,731.03 

12 20914604116405INR 02 3/12/2009 5/10/2009 $4,583.19 

13 20918805264805INR 02 4/12/2009 6/10/2009 $1,701.34 

14 20920200533505INR 02 5/11/2009 7/9/2009 $3,731.03 

15 20926103486505INR 02 6/5/2009 8/3/2009 $2,795.39 

16 20923100546805INR 02 6/11/2009 8/9/2009 $3,767.94 

17 20929202592405INR 02 8/4/2009 10/2/2009 $4,001.17 

18 20931300749405INR 8/10/2009 10/8/2009 $1,701.34 

19 21001103747705INR 10/3/2009 12/1/2009 $3,731.03 

20 21003501037505INR 11/12/2009 1/10/2010 $6,470.08 

21 21003501036905INR 12/12/2009 1/26/2010 $1,617.82 

22 21009101187705INR 1/11/2010 3/11/2010 $4,340.27 

23 21016200942505INR 3/12/2010 5/10/2010 $2,944.72 

24 21015201658405INR 3/16/2010 5/14/2010 $1,618.25 

25 21021601136105INR 5/11/2010 6/23/2010 $1,737.40 

26 21021601135805INR 5/15/2010 7/13/2010 $4,700.09 

27 21106602907008INR 9/12/2010 11/10/2010 $3,515.05 

28 21103901230505INR 10/23/2010 12/21/2010 $4,680.40 

29 21117300906405INR 11/10/2010 1/2/2011 $1,508.53 

30 21103901229805INR 11/11/2010 1/9/2011 $1,508.53 

31 21109401623105INR 12/9/2010 2/6/2011 $6,029.70 

32 21109401620405INR 12/22/2010 2/19/2011 $4,045.79 

33 21113801733405INR 2/7/2011 4/7/2011 $4,126.05 

34 21113801731505INR 2/20/2011 4/20/2011 $1,619.97 

35 21126603634105INR 3/1/2011 4/29/2011 $5,269.30 

36 21117300905405INR 3/30/2011 5/28/2011 $1,508.53 

37 21120100660605INR 4/8/2011 6/6/2011 $4,381.12 

38 21127023165005INRU 4/30/2011 6/28/2011 $2,627.54 

39 21122400046505INR 5/29/2011 7/27/2011 $3,808.84 

40 21122400047505INR 6/7/2011 8/5/2011 $1,929.04 

41 21127023165105INRU 6/29/2011 8/27/2011 $5,101.01 

42 21128005287005INR 7/28/2011 9/25/2011 $1,347.18 

43 21129103655405INR 8/6/2011 10/4/2011 $2,460.36 

USDC IN/ND case 2:13-cv-00145-JTM-JPK document 54-4 filed 01/09/20 page 1 of 2
Claims Paid by Medicare to Adarna

For Conrado Castor's Home Health Care Referrals

For the period July 22, 2008 through January 13, 2014

Exhibit 1 D

Page 2 of 2

Claim Claim Number Claim 

From Date

Claim To 

Date

Claim 

Reimbursem

ent

44 21131807609105INR 8/20/2011 10/18/2011 $1,545.53 

45 21132500240705INR 8/28/2011 10/26/2011 $2,590.54 

46 21134204183705INR 9/26/2011 11/24/2011 $1,347.18 

47 21135402864805INR 10/5/2011 12/3/2011 $1,929.04 

48 21201102395705INR 10/19/2011 12/17/2011 $1,886.78 

49 21201102395205INR 10/27/2011 12/25/2011 $1,347.18 

50 21203100200805INR 11/25/2011 1/23/2012 $1,329.69 

51 21203702358505INR 12/4/2011 1/31/2012 $1,847.13 

52 21205201405905INR 12/18/2011 2/15/2012 $1,329.69 

53 21206900143105INR 12/26/2011 2/23/2012 $1,461.22 

54 21210101153605INR 1/24/2012 3/23/2012 $1,329.69 

55 21213000900705INR 2/16/2012 4/15/2012 $1,329.69 

56 21213000900605INR 2/24/2012 4/23/2012 $1,329.69 

57 21215001748007INR 3/24/2012 5/22/2012 $1,329.69 

58 21220602880407INR 4/20/2012 6/18/2012 $5,655.13 

59 21218403713707INR 4/24/2012 6/22/2012 $1,461.22 

60 21221700004807INR 5/23/2012 7/21/2012 $1,329.69 

61 21224203479707INR 6/19/2012 8/17/2012 $4,228.17 

62 21224203476507INR 6/23/2012 8/21/2012 $1,329.69 

63 21229703164107INR 8/18/2012 9/12/2012 $1,455.09 

64 21235402554707INR 8/22/2012 10/20/2012 $1,329.69 

65 21312202345207INRU 9/20/2012 11/18/2012 $1,329.69 

66 21235202748507INR 10/17/2012 12/5/2012 $5,368.91 

67 21304601056407INR 11/19/2012 1/17/2013 $430.78 

68 21319103190307INR 11/29/2012 1/27/2013 $2,114.26 

69 21308502904707INR 1/18/2013 3/18/2013 $1,361.88 

70 21311601332507INR 1/28/2013 3/28/2013 $2,114.26 

71 21314102878007INR 3/19/2013 5/17/2013 $1,334.64 

72 21319103190407INR 3/29/2013 5/27/2013 $422.18 

73 21322103237007INR 5/18/2013 7/16/2013 $1,334.64 

74 21322103237907INR 5/28/2013 6/20/2013 $316.64 

75 21328201880607INR 7/8/2013 9/5/2013 $5,936.20 

76 21328201879507INR 7/17/2013 9/14/2013 $1,334.64 

77 21331800591807INR 9/6/2013 11/4/2013 $4,623.73 

78 21332200613407INR 11/5/2013 11/5/2013 $2,114.53 

79 21333902208007INR 11/14/2013 11/14/2013 $680.94 

80 21404104222207INR 1/4/2014 1/4/2014 $1,763.06 

81 21404104223207INR 1/9/2014 1/9/2014 $2,951.40 

82 21404104222007INR 1/13/2014 1/13/2014 $687.66 

$211,308.46

USDC IN/ND case 2:13-cv-00145-JTM-JPK document 54-4 filed 01/09/20 page 2 of 2