9,862 Services Per Day: The Most Impossible Doctor in America

Published February 2026 · 12 min read

Let's Do the Math

Madhavi Rayapudi is an Infectious Disease specialist in Cumming, GA. According to Medicare billing data, in 2023 this single provider submitted 2.5M services to Medicare.

Let that number sink in. Here's what it means:

Think about that: one service every 2.9 seconds. Not a minute — seconds. For 8 hours straight. Every working day. For an entire year.

For context, it takes about 3 seconds to say "hello, how are you?" This provider would need to complete an entire Medicare-billable service in that time. No examination. No documentation. No hand-washing between patients.

The Per-Patient Numbers Are Just as Wild

This provider has 2.4K beneficiaries. That means each patient received an average of 1.0K services over the year — roughly 85 services per month per patient.

What kind of patient gets 85 infectious disease services every single month?

25.5% of billing is drugs — suggesting a significant portion of these "services" may be drug administration or dispensing codes. But even so, the volumes are staggering.

She's Not Alone

Our analysis flagged 200 providers with mathematically impossible billing patterns. Here are the top 10:

What's Going On?

There are a few possible explanations:

1. Incident-to billing: In some arrangements, services provided by staff (nurses, PAs) can be billed under the supervising physician's NPI. This is legal but can make one provider look impossibly productive.

2. Lab/drug codes: Some providers bill large numbers of lab tests or drug administration codes per patient encounter. A single visit might generate dozens of line items.

3. Data aggregation: Some NPIs represent practices or groups rather than individuals, despite being listed as individual providers.

4. Fraud: Billing for services never provided is a federal crime — but it happens. The OIG has prosecuted providers with similar volume patterns.

We're not accusing anyone of fraud. But when one doctor bills for a service every 2.9 seconds for an entire year, the math demands an explanation.

The System Doesn't Catch This Automatically

Perhaps the most troubling aspect: Medicare processed and paid these claims. The system lacks automated volume checks that would flag a single provider billing 9.9K services per day.

CMS has fraud detection systems, and the OIG investigates tips and patterns. But with 1.3 million providers billing Medicare annually, manual review catches only a fraction of impossible billing.

The Bottom Line

Either these are data errors, billing structure artifacts, or something extraordinary is happening. In any case, 2.5M services from a single provider in a single year deserves scrutiny. The data is public. The math is simple. And the questions remain unanswered.