Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 91.8% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #99 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 $153.0K in total Medicare payments ranks in the 81th percentile of Allergy/Immunology providers nationally.
Medicare payments to this provider grew 106% 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 | 671 | $32.9K | $49.01 | 1.70x |
| 99214 | Office visit, established patient, moderate complexity | 604 | $29.6K | $49.00 | 1.87x |
| 99215 | Office visit, established patient, high complexity | 537 | $26.3K | $48.99 | 1.47x |
| 99232 | Subsequent hospital care, moderate complexity | 470 | $23.0K | $48.97 | 2.06x |
| 99233 | Subsequent hospital care, high complexity | 403 | $19.7K | $48.96 | 1.49x |
| 93000 | Electrocardiogram, complete | 336 | $16.4K | $48.93 | 1.70x |
| 71046 | Chest X-ray, 2 views | 269 | $13.2K | $48.90 | 1.63x |
| 80053 | Comprehensive metabolic panel | 201 | $9.9K | $49.08 | 1.71x |
| 85025 | Complete blood count with differential | 134 | $6.6K | $49.08 | 1.62x |
| 36415 | Venipuncture for blood draw | 67 | $3.3K | $49.07 | 1.76x |
This provider submits charges 1.78 times higher than what Medicare actually pays.
A markup ratio of 1.78x means for every $100 Medicare pays, this provider initially charges $178. 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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