Statistical flag only — not an accusation of fraud
This provider's $1.5M in total Medicare payments ranks in the 89th percentile of Hematology-Oncology providers nationally.
Their average markup ratio of 29.16x is significantly above the specialty median of 3.5x.
Medicare payments to this provider grew 77% from 2014 to 2023.
This provider has been statistically flagged with a risk score of 66/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
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 | $454.90 | $15.60 | 29.16x | $439.30 | $105.5K | 6.8K | 198 |
| 2015 | $454.90 | $15.60 | 29.16x | $439.30 | $114.6K | 7.3K | 215 |
| 2016 | $454.90 | $15.60 | 29.16x | $439.30 | $123.6K | 7.9K | 232 |
| 2017 | $454.90 | $15.60 | 29.16x | $439.30 | $132.6K | 8.5K | 249 |
| 2018 | $454.90 | $15.60 | 29.16x | $439.30 | $141.7K | 9.1K | 266 |
| 2019 | $454.90 | $15.60 | 29.16x | $439.30 | $150.7K | 9.7K | 283 |
| 2020 | $454.90 | $15.60 | 29.16x | $439.30 | $159.8K | 10.2K | 300 |
| 2021 | $454.90 | $15.60 | 29.16x | $439.30 | $168.8K | 10.8K | 317 |
| 2022 | $454.90 | $15.60 | 29.16x | $439.30 | $177.9K | 11.4K | 334 |
| 2023 | $454.90 | $15.60 | 29.16x | $439.30 | $186.9K | 12.0K | 351 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99213 | Office/outpatient visit, est patient, low | 33.0K | $514.6K | $15.60 | 34.96x |
| 99214 | Office/outpatient visit, est patient, moderate | 16.5K | $257.3K | $15.60 | 33.30x |
| 99215 | Office/outpatient visit, est patient, high | 11.0K | $171.5K | $15.60 | 26.79x |
| 99223 | Initial hospital care, high complexity | 8.2K | $128.7K | $15.60 | 32.43x |
| 99232 | Subsequent hospital care, moderate | 6.6K | $102.9K | $15.60 | 29.99x |
| 93000 | Electrocardiogram, complete | 5.5K | $85.8K | $15.60 | 25.17x |
| 71046 | Chest X-ray, 2 views | 4.7K | $73.5K | $15.60 | 25.45x |
| 80053 | Comprehensive metabolic panel | 4.1K | $64.3K | $15.60 | 32.30x |
| 85025 | Complete blood count (CBC) | 3.7K | $57.2K | $15.60 | 31.79x |
| 36415 | Venipuncture | 3.3K | $51.5K | $15.60 | 24.91x |
This provider submits charges 29.16 times higher than what Medicare actually pays.
A markup ratio of 29.16x means for every $100 Medicare pays, this provider initially charges $2916. 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.
Other Hematology-Oncology providers in VA for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Thomas Alberico, MD | Norfolk, VA | $38.5M | ⚠️ Flagged |
| Mark Fleming, MD | Hampton, VA | $37.6M | ⚠️ Flagged |
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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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