Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 88.7% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #283 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 $2.2M in total Medicare payments ranks in the 98th percentile of Infectious Disease providers nationally.
Medicare payments to this provider grew 103% 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 | 5.3K | $460.4K | $86.97 | 2.16x |
| 99214 | Office visit, established patient, moderate complexity | 4.8K | $414.4K | $86.98 | 1.68x |
| 99215 | Office visit, established patient, high complexity | 4.2K | $368.3K | $86.97 | 1.87x |
| 99232 | Subsequent hospital care, moderate complexity | 3.7K | $322.3K | $86.96 | 1.66x |
| 99233 | Subsequent hospital care, high complexity | 3.2K | $276.2K | $86.98 | 1.82x |
| 93000 | Electrocardiogram, complete | 2.6K | $230.2K | $86.97 | 2.06x |
| 71046 | Chest X-ray, 2 views | 2.1K | $184.2K | $86.99 | 2.10x |
| 80053 | Comprehensive metabolic panel | 1.6K | $138.1K | $86.98 | 1.82x |
| 85025 | Complete blood count with differential | 1.1K | $92.1K | $86.95 | 2.42x |
| 36415 | Venipuncture for blood draw | 529 | $46.0K | $87.03 | 2.45x |
This provider submits charges 2.07 times higher than what Medicare actually pays.
A markup ratio of 2.07x means for every $100 Medicare pays, this provider initially charges $207. 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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