Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 94.9% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #5 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 $547.0K in total Medicare payments ranks in the 92th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 133% from 2014 to 2023.
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 | $88.28 | $41.02 | 2.15x | $47.26 | $32.8K | 800 | 275 |
| 2015 | $88.32 | $41.04 | 2.15x | $47.28 | $38.3K | 933 | 321 |
| 2016 | $88.34 | $41.05 | 2.15x | $47.29 | $43.8K | 1.1K | 366 |
| 2017 | $88.28 | $41.02 | 2.15x | $47.26 | $49.2K | 1.2K | 412 |
| 2018 | $88.30 | $41.03 | 2.15x | $47.27 | $54.7K | 1.3K | 458 |
| 2019 | $88.30 | $41.03 | 2.15x | $47.27 | $54.7K | 1.3K | 458 |
| 2020 | $88.32 | $41.04 | 2.15x | $47.28 | $60.2K | 1.5K | 504 |
| 2021 | $88.34 | $41.05 | 2.15x | $47.29 | $65.6K | 1.6K | 550 |
| 2022 | $88.30 | $41.03 | 2.15x | $47.27 | $71.1K | 1.7K | 596 |
| 2023 | $88.32 | $41.04 | 2.15x | $47.28 | $76.6K | 1.9K | 641 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office visit, 30-39 minutes | 2.9K | $120.3K | $41.04 | 2.44x |
| 99213 | Established patient office visit, 20-29 minutes | 2.4K | $98.5K | $41.04 | 2.23x |
| 99215 | Established patient office visit, 40-54 minutes | 1.9K | $76.6K | $41.04 | 2.40x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 1.3K | $54.7K | $41.03 | 2.14x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 1.1K | $43.8K | $41.05 | 2.14x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 933 | $38.3K | $41.04 | 2.38x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 800 | $32.8K | $41.02 | 2.47x |
| 99291 | Critical care, first 30-74 minutes | 666 | $27.3K | $41.06 | 2.29x |
| G0463 | Hospital outpatient clinic visit | 666 | $27.3K | $41.06 | 2.29x |
| 99212 | Established patient office visit, 10-19 minutes | 666 | $27.3K | $41.06 | 2.08x |
This provider submits charges 2.15 times higher than what Medicare actually pays.
A markup ratio of 2.15x means for every $100 Medicare pays, this provider initially charges $215. 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.
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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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