Statistical flag only — not an accusation of fraud
⚠️ This provider averages 255 services per working day — physically unusual for an individual practitioner
Based on 636.4K total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $11.0M in total Medicare payments ranks in the 99th percentile of Physician Assistant providers nationally.
Their average markup ratio of 5.25x is significantly above the specialty median of 4.8x.
Averaging 255 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 77793% from 2014 to 2023.
This provider has been statistically flagged with a risk score of 73/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 61906% in 2020
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 | $206.58 | $65.80 | 3.14x | $140.78 | $3.8K | 57 | 1 |
| 2015 | $208.39 | $52.86 | 3.94x | $155.53 | $1.5K | 28 | 1 |
| 2016 | $208.06 | $41.73 | 4.99x | $166.33 | $751.07 | 18 | 1 |
| 2017 | $237.40 | $66.26 | 3.58x | $171.14 | $2.8K | 43 | 2 |
| 2018 | $226.41 | $59.72 | 3.79x | $166.69 | $1.9K | 32 | 1 |
| 2019 | $229.18 | $55.63 | 4.12x | $173.55 | $3.1K | 55 | 2 |
| 2020 | $71.46 | $16.33 | 4.38x | $55.13 | $1.9M | 116.2K | 16 |
| 2021 | $91.87 | $17.45 | 5.26x | $74.42 | $3.2M | 183.4K | 20 |
| 2022 | $96.97 | $17.49 | 5.54x | $79.48 | $2.9M | 168.6K | 22 |
| 2023 | $95.85 | $17.39 | 5.51x | $78.46 | $2.9M | 168.0K | 20 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J9271 | Injection, pembrolizumab, 1 mg | 100.8K | $4.2M | $42.01 | 3.69x |
| J1569 | Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg | 60.9K | $2.2M | $35.96 | 7.17x |
| J0897 | Injection, denosumab, 1 mg | 86.3K | $1.4M | $16.76 | 3.94x |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 22.6K | $719.6K | $31.85 | 9.69x |
| J2182 | Injection, mepolizumab, 1 mg | 26.8K | $615.9K | $22.98 | 4.68x |
| J9299 | Injection, nivolumab, 1 mg | 16.9K | $389.0K | $22.97 | 4.66x |
| J0517 | Injection, benralizumab, 1 mg | 2.8K | $372.9K | $135.12 | 3.65x |
| J9312 | Injection, rituximab, 10 mg | 4.8K | $311.2K | $64.83 | 5.22x |
| J1439 | Injection, ferric carboxymaltose, 1 mg | 268.4K | $236.3K | $0.88 | 7.49x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 2.1K | $178.4K | $83.60 | 8.61x |
| 96365 | Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less | 1.2K | $48.3K | $40.67 | 6.73x |
| J3240 | Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial | 25 | $36.2K | $1.4K | 2.99x |
| J2506 | Injection, pegfilgrastim, excludes biosimilar, 0.5 mg | 289 | $35.3K | $122.09 | 5.96x |
| 96372 | Injection of drug or substance under skin or into muscle | 3.2K | $27.5K | $8.56 | 9.21x |
| 96366 | Infusion into a vein for therapy, prevention, or diagnosis, each additional hour | 1.8K | $22.4K | $12.64 | 7.66x |
| 96375 | Injection of additional new drug or substance into vein | 1.6K | $16.2K | $10.04 | 11.43x |
| 96417 | Administration of additional new drug or substance into vein, 1 hour or less | 347 | $14.7K | $42.28 | 7.24x |
| 99214 | Established patient office or other outpatient, visit typically 25 minutes | 213 | $12.5K | $58.66 | 3.68x |
| 96374 | Injection of drug or substance into vein | 452 | $10.5K | $23.30 | 8.70x |
| 96402 | Administration of hormonal anti-neoplastic chemotherapy under skin or into muscle | 450 | $9.0K | $19.97 | 7.19x |
This provider submits charges 5.25 times higher than what Medicare actually pays.
A markup ratio of 5.25x means for every $100 Medicare pays, this provider initially charges $525. 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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