Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 93.6% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #26 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 $797.1K in total Medicare payments ranks in the 95th percentile of Otolaryngology providers nationally.
Medicare payments to this provider grew 115% 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 | 4.7K | $172.7K | $36.82 | 3.44x |
| 99214 | Office visit, established patient, moderate complexity | 4.2K | $155.5K | $36.82 | 2.93x |
| 99215 | Office visit, established patient, high complexity | 3.8K | $138.2K | $36.82 | 3.34x |
| 99232 | Subsequent hospital care, moderate complexity | 3.3K | $120.9K | $36.82 | 3.11x |
| 99233 | Subsequent hospital care, high complexity | 2.8K | $103.6K | $36.82 | 2.57x |
| 93000 | Electrocardiogram, complete | 2.3K | $86.4K | $36.81 | 2.89x |
| 71046 | Chest X-ray, 2 views | 1.9K | $69.1K | $36.81 | 2.83x |
| 80053 | Comprehensive metabolic panel | 1.4K | $51.8K | $36.83 | 2.58x |
| 85025 | Complete blood count with differential | 938 | $34.5K | $36.83 | 2.58x |
| 36415 | Venipuncture for blood draw | 469 | $17.3K | $36.83 | 2.73x |
This provider submits charges 2.93 times higher than what Medicare actually pays.
A markup ratio of 2.93x means for every $100 Medicare pays, this provider initially charges $293. 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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