4,636 Doctors Billing the Impossible

When we ran the numbers on every Medicare provider in the United States — 1.17 million of them — we found 4,636 providers billing more services per working day than any human could possibly deliver. The top name on the list? Madhavi Rayapudi, an infectious disease doctor in Cumming, Georgia, who billed 9,862 services per day.

That's one service every 0.05 seconds. Not every minute. Every fraction of a second. Twenty-four hours a day wouldn't be enough. A hundred hours a day wouldn't be enough.

The Top 10: Impossible by the Numbers

These are the ten providers with the highest services-per-day rates in all of Medicare. Every single one bills over 4,000 “services” per working day. Look at the drug share percentage — it tells the real story.

The J-Code Effect: Why the Numbers Lie

Medicare's billing system was designed in an era of office visits and surgical procedures. When injectable drugs entered the picture — chemotherapy, biologics, IV antibiotics — the system wasn't redesigned. Instead, each unit of each drug became a “service.”

Consider a rheumatologist administering Rituximab to a patient. A single infusion might be billed as 500+ individual “services” — one for each milligram unit. The doctor sees one patient, performs one procedure, but Medicare records 500 services. Multiply by 10-20 patients per day, and suddenly you're at 5,000-10,000 “services.”

This is why Hematology-Oncology and Rheumatology dominate our impossible list. These specialties administer the most expensive, highest-unit-count injectable drugs in medicine.

Specialty Breakdown

Of the 4,636 impossible providers, the distribution by specialty reveals the drug-billing pattern:

The Ones That Aren't J-Codes

But not every impossible number can be explained by drug billing. Look at Sheeba Mathai, a nurse practitioner in Frisco, Texas: 5,509 services per day, 0% drug billing, and a code concentration of 1.0 — meaning every single service is the same procedure code. Her 1.37 million services went to 169,879 beneficiaries, all coded as COVID testing.

Or David Chess, a geriatric medicine doctor in Stratford, Connecticut: 3,390 services per day to 209,711 beneficiaries — more patients than the entire population of most Connecticut cities. His $41.7 million in payments with zero drug billing raises very different questions than the oncologists.

These outliers — the ones with low drug percentages and impossibly high patient counts — are where the real investigative questions begin. The J-code providers are gaming a broken counting system. The non-drug impossible providers may be gaming something else entirely.

The COVID Factor

A significant subset of impossible providers — including Sheeba Mathai, Merry Taheri, and Linda Bankovich — show 99-100% COVID share in their billing. During the pandemic, mass testing sites could legitimately process thousands of patients per day, with each test counted as a service under the provider's NPI.

These aren't individual doctors seeing individual patients. They're billing entities — testing sites, mobile clinics, drive-through operations — where the NPI serves as an organizational identifier more than a personal one.

What This Means for Fraud Detection

The “services per day” metric — which seems like the ultimate fraud indicator — turns out to be deeply flawed when applied without context. A naive algorithm flagging anyone over 100 services per day would catch every oncologist in America who administers chemotherapy.

This is why our full impossible doctors analysis uses multiple signals: drug share percentage, code concentration, beneficiary counts, and specialty Z-scores. The goal isn't to flag high-volume billers — it's to find the ones whose volume can't be explained by any legitimate billing pattern.

The Systemic Problem

The real scandal isn't 4,636 individual providers. It's that Medicare's service counting system makes it impossible to distinguish a doctor who saw 50 patients from one who saw 5 patients but administered expensive drugs to each of them. The metric is broken at a structural level.

Until CMS reforms how drug units are counted — separating “hands-on services” from “drug unit administration” — the data will continue to produce these misleading headlines. And real fraud will continue to hide behind the noise.

Explore Further

• Interactive Impossible Numbers Dashboard — Explore all 4,636 providers with filtering and sorting
• The Impossible Doctors — Our original investigation into billing impossibilities