Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 95.3% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #8 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 $724.7K in total Medicare payments ranks in the 94th 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 | $110.23 | $55.53 | 1.99x | $54.70 | $43.5K | 783 | 244 |
| 2015 | $110.29 | $55.56 | 1.99x | $54.73 | $50.7K | 913 | 285 |
| 2016 | $110.23 | $55.53 | 1.99x | $54.70 | $58.0K | 1.0K | 325 |
| 2017 | $110.29 | $55.56 | 1.99x | $54.73 | $65.2K | 1.2K | 366 |
| 2018 | $110.33 | $55.58 | 1.99x | $54.75 | $72.5K | 1.3K | 407 |
| 2019 | $110.33 | $55.58 | 1.99x | $54.75 | $72.5K | 1.3K | 407 |
| 2020 | $110.27 | $55.55 | 1.99x | $54.72 | $79.7K | 1.4K | 447 |
| 2021 | $110.31 | $55.57 | 1.99x | $54.74 | $87.0K | 1.6K | 488 |
| 2022 | $110.27 | $55.55 | 1.99x | $54.72 | $94.2K | 1.7K | 529 |
| 2023 | $110.29 | $55.56 | 1.99x | $54.73 | $101.5K | 1.8K | 569 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office visit, 30-39 minutes | 2.9K | $159.4K | $55.55 | 1.84x |
| 99213 | Established patient office visit, 20-29 minutes | 2.3K | $130.4K | $55.56 | 2.28x |
| 99215 | Established patient office visit, 40-54 minutes | 1.8K | $101.5K | $55.56 | 2.06x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 1.3K | $72.5K | $55.58 | 1.94x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 1.0K | $58.0K | $55.53 | 2.05x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 913 | $50.7K | $55.56 | 2.16x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 783 | $43.5K | $55.53 | 2.05x |
| 99291 | Critical care, first 30-74 minutes | 652 | $36.2K | $55.58 | 2.24x |
| G0463 | Hospital outpatient clinic visit | 652 | $36.2K | $55.58 | 1.72x |
| 99212 | Established patient office visit, 10-19 minutes | 652 | $36.2K | $55.58 | 1.92x |
This provider submits charges 1.99 times higher than what Medicare actually pays.
A markup ratio of 1.99x means for every $100 Medicare pays, this provider initially charges $199. This is lower 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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