Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 86.8% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #428 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 averages 490 services per working day — physically unusual for an individual practitioner
Based on 367.7K total services over 3 years (250 working days/year). Learn about impossible service volumes →
This provider's $3.6M in total Medicare payments ranks in the 95th percentile of Hematology-Oncology providers nationally.
Averaging 490 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 6323% from 2021 to 2023.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 759% 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 | $6.52 | $2.74 | 2.38x | $3.78 | $49.2K | 18.0K | 12 |
| 2022 | $14.77 | $5.39 | 2.74x | $9.38 | $368.3K | 68.3K | 32 |
| 2023 | $28.43 | $11.24 | 2.53x | $17.19 | $3.2M | 281.4K | 47 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J9271 | Injection, pembrolizumab, 1 mg | 30.0K | $1.3M | $43.37 | 2.42x |
| J9144 | Injection, daratumumab, 10 mg and hyaluronidase-fihj | 23.6K | $886.6K | $37.60 | 2.39x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 3.3K | $308.5K | $94.84 | 2.30x |
| J0897 | Injection, denosumab, 1 mg | 14.3K | $262.3K | $18.37 | 2.29x |
| 99215 | Established patient office or other outpatient visit, 40-54 minutes | 748 | $103.3K | $138.10 | 2.13x |
| Q0138 | Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (non-esrd use) | 207.6K | $96.5K | $0.47 | 4.30x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 957 | $96.4K | $100.72 | 2.78x |
| J2506 | Injection, pegfilgrastim, excludes biosimilar, 0.5 mg | 432 | $55.8K | $129.22 | 2.82x |
| Q5106 | Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units | 8.3K | $50.7K | $6.11 | 2.62x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 334 | $41.6K | $124.68 | 2.68x |
| 99205 | New patient office or other outpatient visit, 60-74 minutes | 226 | $38.4K | $169.94 | 2.48x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 556 | $35.8K | $64.44 | 2.33x |
| 80053 | Blood test, comprehensive group of blood chemicals | 3.0K | $30.7K | $10.36 | 2.89x |
| 96365 | Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less | 549 | $27.1K | $49.33 | 3.00x |
| 96367 | Infusion into a vein for therapy, prevention, or diagnosis, additional sequential infusion, 1 hour or less | 1.2K | $26.3K | $22.32 | 2.82x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | 3.2K | $24.4K | $7.60 | 2.89x |
| 36415 | Insertion of needle into vein for collection of blood sample | 3.0K | $20.3K | $6.84 | 2.05x |
| 96417 | Administration of additional new drug or substance into vein, 1 hour or less | 366 | $18.2K | $49.85 | 2.79x |
| 96401 | Administration of non-hormonal anti-neoplastic chemotherapy under skin or into muscle | 260 | $14.2K | $54.68 | 2.89x |
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | 97 | $13.8K | $142.64 | 2.91x |
This provider submits charges 2.55 times higher than what Medicare actually pays.
A markup ratio of 2.55x means for every $100 Medicare pays, this provider initially charges $255. 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 FL for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Christopher Lobo, MD | Port Charlotte, FL | $60.5M | ⚠️ Flagged |
| Maen Hussein, M.D. | Tavares, FL | $57.6M | ✓ Clear |
| Vikas Malhotra, M.D. | Spring Hill, FL | $52.8M | ✓ Clear |
| Andrew Lipman, M.D. | Naples, FL | $51.1M | ⚠️ Flagged |
| Syed Zafar, M.D. | Fort Myers, FL | $48.1M | ⚠️ 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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