Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 90.0% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #221 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 $541.9K in total Medicare payments ranks in the 92th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 124% 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 | 2.2K | $117.1K | $52.84 | 3.67x |
| 99214 | Office visit, established patient, moderate complexity | 2.0K | $105.4K | $52.85 | 3.46x |
| 99215 | Office visit, established patient, high complexity | 1.8K | $93.7K | $52.86 | 3.05x |
| 99232 | Subsequent hospital care, moderate complexity | 1.6K | $82.0K | $52.84 | 2.79x |
| 99233 | Subsequent hospital care, high complexity | 1.3K | $70.3K | $52.85 | 2.71x |
| 93000 | Electrocardiogram, complete | 1.1K | $58.6K | $52.86 | 3.01x |
| 71046 | Chest X-ray, 2 views | 887 | $46.9K | $52.83 | 3.76x |
| 80053 | Comprehensive metabolic panel | 665 | $35.1K | $52.85 | 3.37x |
| 85025 | Complete blood count with differential | 443 | $23.4K | $52.89 | 3.03x |
| 36415 | Venipuncture for blood draw | 222 | $11.7K | $52.77 | 3.42x |
This provider submits charges 3.27 times higher than what Medicare actually pays.
A markup ratio of 3.27x means for every $100 Medicare pays, this provider initially charges $327. 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.
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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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