Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 94.4% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #32 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 $832.6K in total Medicare payments ranks in the 95th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 132% 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 | 3.7K | $178.8K | $48.27 | 1.98x |
| 99214 | Office visit, established patient, moderate complexity | 3.3K | $160.9K | $48.28 | 1.92x |
| 99215 | Office visit, established patient, high complexity | 3.0K | $143.0K | $48.28 | 2.04x |
| 99232 | Subsequent hospital care, moderate complexity | 2.6K | $125.1K | $48.28 | 1.79x |
| 99233 | Subsequent hospital care, high complexity | 2.2K | $107.3K | $48.27 | 2.27x |
| 93000 | Electrocardiogram, complete | 1.9K | $89.4K | $48.29 | 2.40x |
| 71046 | Chest X-ray, 2 views | 1.5K | $71.5K | $48.28 | 1.85x |
| 80053 | Comprehensive metabolic panel | 1.1K | $53.6K | $48.27 | 1.72x |
| 85025 | Complete blood count with differential | 741 | $35.8K | $48.25 | 2.25x |
| 36415 | Venipuncture for blood draw | 370 | $17.9K | $48.31 | 1.96x |
This provider submits charges 2.02 times higher than what Medicare actually pays.
A markup ratio of 2.02x means for every $100 Medicare pays, this provider initially charges $202. 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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