The Million-Dollar Club

Most of the 500 providers flagged by our AI model bill Medicare in the hundreds of thousands per year — enough to trigger statistical alarm bells, but not enough to stand out in raw dollar terms. Then there are the 47 who crossed the million-dollar threshold.

These aren't just providers with suspicious billing patterns. They're providers with suspicious billing patterns and massive volume. Collectively, they billed Medicare over $93.4M — an average of $2.0M each. Their average fraud probability score is 92.1%.

Not all big billers are fraudsters. Oncologists routinely bill millions due to expensive drug costs. Large group practices can legitimately bill tens of millions. But when a provider bills over $1 million and their billing pattern matches convicted criminals across every metric our model tracks — volume, markup, services per patient, geographic concentration — that's a different story.

The Biggest Billers

At the top of the million-dollar club sits Terrance Hughes, an Illinois internist who billed Medicare $5.3M. That's more than six times the average for Internal Medicine providers — and his billing pattern matches convicted fraudsters with a 91.2% probability score.

What Makes High-Volume Flagged Providers Different?

The million-dollar flagged providers aren't just scaled-up versions of typical suspicious billers. They have a distinct profile:

The million-dollar group has higher markup ratios, more services per beneficiary, and is even more concentrated in Internal Medicine than the broader flagged pool. They're not just billing more — they're billing differently. Higher intensity per patient, higher charges relative to what Medicare allows, and more services packed into each patient encounter.

Not All Big Billers Are Fraudsters — But These Match the Pattern

This is an important distinction. Medicare has thousands of providers who legitimately bill over $1 million per year. Oncologists administering chemotherapy drugs can bill $5–10M+. Large multi-provider group practices bill tens of millions. High-volume surgical practices serve hundreds of patients.

What sets the million-dollar club apart isn't the dollar amount — it's that these providers match convicted fraudsters across every dimension our model evaluates:

The question isn't whether these providers are billing a lot of money. Plenty of legitimate providers do. The question is why their billing patterns look identical to people who went to prison.