Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 92.3% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #112 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 $789.2K in total Medicare payments ranks in the 93th percentile of Physical Medicine and Rehabilitation providers nationally.
Medicare payments to this provider grew 107% 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 | 2.1K | $169.2K | $79.14 | 1.93x |
| 99214 | Office visit, established patient, moderate complexity | 1.9K | $152.3K | $79.15 | 2.21x |
| 99215 | Office visit, established patient, high complexity | 1.7K | $135.4K | $79.16 | 2.12x |
| 99232 | Subsequent hospital care, moderate complexity | 1.5K | $118.4K | $79.18 | 2.06x |
| 99233 | Subsequent hospital care, high complexity | 1.3K | $101.5K | $79.13 | 2.04x |
| 93000 | Electrocardiogram, complete | 1.1K | $84.6K | $79.14 | 2.49x |
| 71046 | Chest X-ray, 2 views | 855 | $67.7K | $79.16 | 2.52x |
| 80053 | Comprehensive metabolic panel | 641 | $50.8K | $79.20 | 2.57x |
| 85025 | Complete blood count with differential | 428 | $33.8K | $79.07 | 2.36x |
| 36415 | Venipuncture for blood draw | 214 | $16.9K | $79.07 | 2.01x |
This provider submits charges 2.31 times higher than what Medicare actually pays.
A markup ratio of 2.31x means for every $100 Medicare pays, this provider initially charges $231. 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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