Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 90.6% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #119 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 $638.9K in total Medicare payments ranks in the 75th percentile of Hematology/Oncology providers nationally.
Medicare payments to this provider grew 121% 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 | 4.2K | $138.4K | $33.06 | 2.49x |
| 99214 | Office visit, established patient, moderate complexity | 3.8K | $124.6K | $33.07 | 2.02x |
| 99215 | Office visit, established patient, high complexity | 3.3K | $110.7K | $33.06 | 2.53x |
| 99232 | Subsequent hospital care, moderate complexity | 2.9K | $96.9K | $33.07 | 2.06x |
| 99233 | Subsequent hospital care, high complexity | 2.5K | $83.0K | $33.07 | 2.22x |
| 93000 | Electrocardiogram, complete | 2.1K | $69.2K | $33.06 | 2.95x |
| 71046 | Chest X-ray, 2 views | 1.7K | $55.4K | $33.07 | 2.64x |
| 80053 | Comprehensive metabolic panel | 1.3K | $41.5K | $33.06 | 2.00x |
| 85025 | Complete blood count with differential | 837 | $27.7K | $33.07 | 2.70x |
| 36415 | Venipuncture for blood draw | 419 | $13.8K | $33.03 | 2.47x |
This provider submits charges 2.47 times higher than what Medicare actually pays.
A markup ratio of 2.47x means for every $100 Medicare pays, this provider initially charges $247. 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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