Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 93.6% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #33 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 $632.2K in total Medicare payments ranks in the 90th percentile of Pulmonary Disease providers nationally.
Medicare payments to this provider grew 120% 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 | 2.7K | $138.2K | $50.58 | 1.98x |
| 99214 | Office visit, established patient, moderate complexity | 2.5K | $124.4K | $50.59 | 1.71x |
| 99215 | Office visit, established patient, high complexity | 2.2K | $110.6K | $50.58 | 1.94x |
| 99232 | Subsequent hospital care, moderate complexity | 1.9K | $96.8K | $50.58 | 2.28x |
| 99233 | Subsequent hospital care, high complexity | 1.6K | $82.9K | $50.57 | 2.06x |
| 93000 | Electrocardiogram, complete | 1.4K | $69.1K | $50.59 | 2.27x |
| 71046 | Chest X-ray, 2 views | 1.1K | $55.3K | $50.58 | 2.51x |
| 80053 | Comprehensive metabolic panel | 820 | $41.5K | $50.57 | 2.34x |
| 85025 | Complete blood count with differential | 547 | $27.6K | $50.54 | 1.97x |
| 36415 | Venipuncture for blood draw | 273 | $13.8K | $50.63 | 2.47x |
This provider submits charges 2.13 times higher than what Medicare actually pays.
A markup ratio of 2.13x means for every $100 Medicare pays, this provider initially charges $213. 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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