The Impossible Doctors

Some Medicare providers bill for more than 400 services per working day. That's a new patient every 1.2 minutes, for 8 hours straight, with no breaks. Either these are the fastest doctors in America, or something else is going on.

The Math

Let's start with simple arithmetic. There are roughly 250 working days in a year (52 weeks × 5 days, minus holidays). An 8-hour clinical day gives you 480 minutes.

For a provider billing 400 services per working day:

Even the most efficient clinical operation — say, a flu shot clinic — would struggle to process patients at this rate. For complex medical services, it's physically impossible.

100+ Unique Beneficiaries Per Day

Service volume alone isn't the only red flag. Some of these providers also billed for over 100 unique Medicare beneficiaries per working day. That means they weren't just billing multiple services per patient — they were allegedly seeing a new person every few minutes, all day long.

Consider what a real patient encounter involves: checking in, reviewing history, performing an examination, discussing treatment, documenting findings, and processing billing. Even for a routine visit, 10-15 minutes is the bare minimum. At 100+ unique patients per day, you're looking at 4-5 minutes per person — assuming zero downtime.

Walking Through a Day

Let's imagine the day of a provider billing 400 services:

Try It Yourself

Enter any provider's total services and time period to see if their numbers are physically possible:

"But What About..."

There are legitimate explanations for some high-volume billing:

• Group practices billing under one NPI — Multiple practitioners sometimes bill under a single provider number. This inflates the apparent volume for one person.
• Lab-like operations — Some individual NPIs function more like laboratories, processing high volumes of simple tests.
• Supply distribution — Providers shipping supplies (like COVID test kits) can generate high service counts without individual patient encounters.

These explanations are valid for some providers. But when an individual practitioner — listed as a solo nurse practitioner or a single physician — bills for 400+ services per day, the burden of explanation shifts. Something needs to account for those numbers.

What the Data Reveals

Our analysis of 1.1M Medicare providers identified 4.6K individual providers (not organizations) whose billing volumes defy physical constraints. The most extreme case: Madhavi Rayapudi, who averaged 9.9K services per working day. These providers share common characteristics:

• 200+ services per working day averaged over multiple years
• Billing under individual (not organizational) NPIs
• High risk scores across multiple fraud detection dimensions
• Often concentrated in a few geographic areas
• Frequently billing codes associated with known fraud schemes (K1034, Q4xxx)

The Question We Should Be Asking

The question isn't whether these providers are committing fraud — that's for investigators and courts to determine. The question is: why does the system allow it?

Medicare processes billions of claims per year. A simple automated check — flagging any individual provider billing more than, say, 100 services per working day — would catch the most extreme anomalies in real time. The fact that providers can bill at impossible rates for years without automated intervention suggests a system that isn't designed for prevention.

CMS has the data. The math is simple. The flags are obvious. The question is whether anyone is looking.