Statistical flag only — not an accusation of fraud
This provider's $7.5M in total Medicare payments ranks in the 99th percentile of Mass Immunizer Roster Biller providers nationally.
Medicare payments to this provider grew 44362% from 2021 to 2023.
100% of their billing comes from a single procedure code (K1034 — Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count).
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.
Notable: Payments increased 357985% in 2023
Year-over-year payment surges can indicate changes in practice volume, new services, or billing pattern shifts.
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 |
|---|---|---|---|---|---|---|---|
| 2021 | $77.42 | $38.30 | 2.02x | $39.12 | $16.8K | 439 | 10 |
| 2022 | $78.02 | $36.63 | 2.13x | $41.39 | $2.1K | 57 | 4 |
| 2023 | $12.22 | $11.76 | 1.04x | $0.46 | $7.5M | 635.8K | 1 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| K1034 | Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count | 635.8K | $7.5M | $11.76 | 1.04x |
| 0012A | Adm sarscov2 100mcg/0.5ml2nd | 78 | $3.2K | $40.77 | 1.77x |
| 0064A | Adm sarscov2 50mcg/0.25mlbst | 58 | $2.4K | $41.05 | 2.07x |
| 0031A | Adm sarscov2 vac ad26 .5ml | 54 | $2.2K | $41.24 | 1.54x |
| 0001A | Adm sarscov2 30mcg/0.3ml 1st | 46 | $1.9K | $41.24 | 2.06x |
| 0002A | Adm sarscov2 30mcg/0.3ml 2nd | 45 | $1.9K | $41.24 | 2.04x |
| 0013A | Fee covid-19 vac 2 booster | 43 | $1.8K | $41.24 | 2.06x |
| 0011A | Adm sarscov2 100mcg/0.5ml1st | 73 | $1.8K | $24.05 | 2.89x |
| 0003A | Fee covid-19 vac 1 booster | 22 | $907.28 | $41.24 | 2.06x |
| 0004A | Fee covid-19 vac 1 res | 19 | $783.56 | $41.24 | 2.06x |
| 0034A | Fee covid-19 vac 4 res | 17 | $701.08 | $41.24 | 2.06x |
| 0134A | Fee covid-19 vac 14 res | 17 | $681.36 | $40.08 | 2.12x |
| 0054A | Adm sarscv2 30mcg trs-sucr b | 13 | $524.73 | $40.36 | 2.11x |
| G0008 | Administration of influenza virus vaccine | 11 | $232.49 | $21.14 | 2.31x |
This provider submits charges 1.04 times higher than what Medicare actually pays.
A markup ratio of 1.04x means for every $100 Medicare pays, this provider initially charges $104. This is lower 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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