Statistical flag only — not an accusation of fraud
⚠️ This provider averages 1.2K services per working day — physically unusual for an individual practitioner
Based on 3.0M total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $49.5M in total Medicare payments ranks in the 99th percentile of Rheumatology providers nationally.
Averaging 1.2K services per working day raises questions about billing patterns.
Medicare payments to this provider grew 203% from 2014 to 2023.
This provider has been statistically flagged with a risk score of 67/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 65% in 2015
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 |
|---|---|---|---|---|---|---|---|
| 2014 | $45.80 | $15.14 | 3.03x | $30.66 | $2.0M | 134.3K | 53 |
| 2015 | $49.07 | $16.54 | 2.97x | $32.53 | $3.4M | 202.8K | 55 |
| 2016 | $46.40 | $15.83 | 2.93x | $30.57 | $4.2M | 263.2K | 58 |
| 2017 | $41.14 | $15.57 | 2.64x | $25.57 | $4.0M | 255.8K | 54 |
| 2018 | $46.78 | $17.23 | 2.72x | $29.55 | $5.0M | 287.7K | 60 |
| 2019 | $68.17 | $23.45 | 2.91x | $44.72 | $5.9M | 251.6K | 53 |
| 2020 | $63.36 | $20.50 | 3.09x | $42.86 | $5.9M | 287.1K | 46 |
| 2021 | $61.90 | $19.48 | 3.18x | $42.42 | $6.4M | 328.3K | 45 |
| 2022 | $42.35 | $13.21 | 3.21x | $29.14 | $6.6M | 501.1K | 53 |
| 2023 | $37.94 | $11.66 | 3.25x | $26.28 | $6.2M | 529.2K | 48 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0897 | Injection, denosumab, 1 mg | 407.0K | $6.0M | $14.76 | 2.82x |
| J0717 | Injection, certolizumab pegol, 1 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered) | 1.1M | $5.5M | $5.25 | 2.66x |
| J9312 | Injection, rituximab, 10 mg | 78.8K | $5.5M | $69.70 | 3.57x |
| J1602 | Injection, golimumab, 1 mg, for intravenous use | 314.4K | $4.6M | $14.59 | 3.48x |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 76.3K | $4.1M | $53.71 | 2.92x |
| J0129 | Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered) | 83.6K | $3.2M | $37.81 | 2.85x |
| J3111 | Injection, romosozumab-aqqg, 1 mg | 377.8K | $2.9M | $7.60 | 2.65x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 28.6K | $2.6M | $92.03 | 2.50x |
| J3357 | Ustekinumab, for subcutaneous injection, 1 mg | 16.0K | $2.3M | $145.83 | 2.75x |
| J9310 | Injection, rituximab, 100 mg | 3.6K | $2.2M | $627.44 | 2.48x |
| 99215 | Established patient office or other outpatient visit, 40-54 minutes | 10.2K | $1.3M | $126.72 | 2.52x |
| J3262 | Injection, tocilizumab, 1 mg | 290.1K | $1.1M | $3.76 | 3.04x |
| 20611 | Aspiration and/or injection of fluid large joint using ultrasound guidance | 9.7K | $773.0K | $79.58 | 2.84x |
| J7322 | Hyaluronan or derivative, hymovis, for intra-articular injection, 1 mg | 31.9K | $672.6K | $21.09 | 3.32x |
| 76881 | Complete ultrasound scan of joint | 6.2K | $571.8K | $91.55 | 3.90x |
| J7326 | Hyaluronan or derivative, gel-one, for intra-articular injection, per dose | 828 | $522.0K | $630.38 | 2.39x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 4.1K | $509.1K | $124.52 | 2.90x |
| 99205 | New patient office or other outpatient visit, 60-74 minutes | 2.9K | $496.5K | $169.90 | 2.63x |
| 37241 | Occlusion of venous malformations (other than hemorrhage) with radiological supervision and interpretation, roadmapping, and imaging guidance | 115 | $481.6K | $4.2K | 2.87x |
| J7323 | Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose | 3.1K | $356.8K | $115.59 | 2.58x |
This provider submits charges 3.02 times higher than what Medicare actually pays.
A markup ratio of 3.02x means for every $100 Medicare pays, this provider initially charges $302. This is higher than the national average.
Always verify provider credentials and location before scheduling appointments. This data reflects Medicare payments and may not include all practice locations.
Other Rheumatology providers in CA for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Barry Eibschutz, M.D. | San Luis Obispo, CA | $55.8M | ✓ Clear |
| Gerald Ho, M.D. | La Palma, CA | $45.8M | ✓ Clear |
| Arash Horizon, M.D. | Los Angeles, CA | $45.0M | ✓ Clear |
| Daniel Watrous, M.D. | Visalia, CA | $41.6M | ✓ Clear |
| Eric Lee, M.D. | Upland, CA | $37.5M | ✓ Clear |
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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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