Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 89.4% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #285 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 $842.6K in total Medicare payments ranks in the 79th percentile of Rheumatology providers nationally.
Medicare payments to this provider grew 122% 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 | 4.2K | $183.5K | $44.03 | 3.72x |
| 99214 | Office visit, established patient, moderate complexity | 3.8K | $165.1K | $44.03 | 4.10x |
| 99215 | Office visit, established patient, high complexity | 3.3K | $146.8K | $44.02 | 3.60x |
| 99232 | Subsequent hospital care, moderate complexity | 2.9K | $128.4K | $44.02 | 5.00x |
| 99233 | Subsequent hospital care, high complexity | 2.5K | $110.1K | $44.03 | 3.98x |
| 93000 | Electrocardiogram, complete | 2.1K | $91.7K | $44.01 | 4.63x |
| 71046 | Chest X-ray, 2 views | 1.7K | $73.4K | $44.02 | 5.09x |
| 80053 | Comprehensive metabolic panel | 1.3K | $55.0K | $44.03 | 5.33x |
| 85025 | Complete blood count with differential | 833 | $36.7K | $44.05 | 3.99x |
| 36415 | Venipuncture for blood draw | 417 | $18.3K | $43.99 | 4.87x |
This provider submits charges 4.45 times higher than what Medicare actually pays.
A markup ratio of 4.45x means for every $100 Medicare pays, this provider initially charges $445. 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 |
| Shariar Cohen-Gadol, M.D. | Thousand Oaks, CA | $49.5M | ⚠️ Flagged |
| 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 |
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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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