Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 91.3% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #130 out of 500 highest-risk providers analyzed. This is a statistical prediction, not a determination of fraud.
ML model prediction — not an accusation of fraud
This provider's $699.7K in total Medicare payments ranks in the 97th percentile of General Surgery providers nationally.
Medicare payments to this provider grew 111% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99213 | Office visit, established patient, low complexity | 3.3K | $152.8K | $46.07 | 3.17x |
| 99214 | Office visit, established patient, moderate complexity | 3.0K | $137.5K | $46.07 | 3.09x |
| 99215 | Office visit, established patient, high complexity | 2.7K | $122.2K | $46.06 | 2.68x |
| 99232 | Subsequent hospital care, moderate complexity | 2.3K | $106.9K | $46.07 | 3.03x |
| 99233 | Subsequent hospital care, high complexity | 2.0K | $91.7K | $46.06 | 2.73x |
| 93000 | Electrocardiogram, complete | 1.7K | $76.4K | $46.07 | 3.04x |
| 71046 | Chest X-ray, 2 views | 1.3K | $61.1K | $46.08 | 2.28x |
| 80053 | Comprehensive metabolic panel | 995 | $45.8K | $46.06 | 2.85x |
| 85025 | Complete blood count with differential | 663 | $30.6K | $46.08 | 2.23x |
| 36415 | Venipuncture for blood draw | 332 | $15.3K | $46.01 | 2.97x |
This provider submits charges 2.64 times higher than what Medicare actually pays.
A markup ratio of 2.64x means for every $100 Medicare pays, this provider initially charges $264. 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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