Statistical flag only — not an accusation of fraud
⚠️ This provider averages 633 services per working day — physically unusual for an individual practitioner
Based on 949.1K total services over 6 years (250 working days/year). Learn about impossible service volumes →
This provider's $17.0M in total Medicare payments ranks in the 99th percentile of Family Practice providers nationally.
Averaging 633 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 233679% from 2017 to 2023.
This provider has been statistically flagged with a risk score of 71/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 2346% in 2022
Year-over-year payment surges can indicate changes in practice volume, new services, or billing pattern shifts.
Average per-service amounts submitted by the provider compared to what Medicare actually paid — the gap represents the markup.
| Year | Avg Submitted | Avg Paid | Markup Ratio | Gap per Service | Total Payments | Services | Beneficiaries |
|---|---|---|---|---|---|---|---|
| 2017 | $317.03 | $69.40 | 4.57x | $247.63 | $6.3K | 91 | 2 |
| 2019 | $340.39 | $73.26 | 4.65x | $267.13 | $26.4K | 361 | 7 |
| 2020 | $414.69 | $93.99 | 4.41x | $320.70 | $12.3K | 131 | 2 |
| 2021 | $2.1K | $253.07 | 8.11x | $1.8K | $87.1K | 344 | 3 |
| 2022 | $258.39 | $66.20 | 3.90x | $192.19 | $2.1M | 32.2K | 27 |
| 2023 | $47.82 | $16.12 | 2.97x | $31.70 | $14.8M | 916.0K | 39 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| K1034 | Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count | 814.0K | $9.6M | $11.76 | 2.55x |
| 99490 | Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month | 46.5K | $2.3M | $49.29 | 4.05x |
| 99439 | Chronic care management services for two or more chronic conditions, additional 20 minutes of clinical staff time directed by health care professional, per calendar month | 45.4K | $1.7M | $37.23 | 2.40x |
| 99305 | Initial nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes | 8.5K | $940.4K | $111.19 | 6.75x |
| M0223 | Intravenous injection, bebtelovimab, includes injection and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency | 837 | $461.9K | $551.86 | 2.72x |
| 99491 | Chronic care management services for two or more chronic conditions, first 30 minutes provided personally by health care professional, per calendar month | 5.4K | $353.7K | $65.78 | 2.40x |
| 99493 | Follow-up psychiatric collaborative care management, subsequent calendar month, first 60 minutes | 2.6K | $288.7K | $110.05 | 3.31x |
| 99437 | Chronic care management services for two or more chronic conditions, additional 30 minutes provided personally by health care professional, per calendar month | 4.9K | $226.7K | $46.41 | 3.13x |
| G0506 | Comprehensive assessment of and care planning for patients requiring chronic care management services (list separately in addition to primary monthly care management service) | 5.5K | $206.9K | $37.43 | 2.90x |
| 99492 | Initial psychiatric collaborative care management, first calendar month, first 70 minutes | 1.6K | $183.4K | $115.73 | 3.24x |
| M0244 | Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital duri | 140 | $113.5K | $810.70 | 8.91x |
| 99484 | Care management services for behavioral health conditions, 20 minutes or more clinical staff time directed by health care professional | 3.1K | $105.4K | $33.54 | 3.30x |
| 99494 | Psychiatric collaborative care management per calendar month, each additional 30 minutes | 1.8K | $78.3K | $44.52 | 4.50x |
| 99308 | Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes | 1.0K | $61.4K | $58.89 | 6.12x |
| G0438 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit | 294 | $47.1K | $160.22 | 1.56x |
| 87811 | Detection test by immunoassay with direct visual observation for severe acute respiratory syndrome coronavirus 2 (covid-19) | 1.0K | $42.0K | $41.10 | 1.95x |
| 99426 | Principal care management services for a single high-risk disease, first 30 minutes of clinical staff time directed by health care professional, per calendar month | 819 | $39.3K | $48.04 | 3.52x |
| 99309 | Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes | 415 | $36.5K | $88.00 | 5.71x |
| M0248 | Intravenous infusion, sotrovimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency | 45 | $34.4K | $763.86 | 13.09x |
| 99211 | Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional | 1.4K | $33.2K | $23.79 | 4.28x |
This provider submits charges 3.11 times higher than what Medicare actually pays.
A markup ratio of 3.11x means for every $100 Medicare pays, this provider initially charges $311. This is higher than the national average.
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Last Updated: February 2026 (data through 2023, the latest CMS release)
Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.
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