Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 87.5% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #432 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 $1.2M in total Medicare payments ranks in the 94th percentile of Pain Management providers nationally.
Medicare payments to this provider grew 112% 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 | 5.5K | $262.8K | $47.93 | 3.18x |
| 99214 | Office visit, established patient, moderate complexity | 4.9K | $236.5K | $47.93 | 4.07x |
| 99215 | Office visit, established patient, high complexity | 4.4K | $210.2K | $47.93 | 3.33x |
| 99232 | Subsequent hospital care, moderate complexity | 3.8K | $183.9K | $47.94 | 4.01x |
| 99233 | Subsequent hospital care, high complexity | 3.3K | $157.7K | $47.93 | 3.67x |
| 93000 | Electrocardiogram, complete | 2.7K | $131.4K | $47.93 | 4.17x |
| 71046 | Chest X-ray, 2 views | 2.2K | $105.1K | $47.93 | 3.80x |
| 80053 | Comprehensive metabolic panel | 1.6K | $78.8K | $47.92 | 3.04x |
| 85025 | Complete blood count with differential | 1.1K | $52.6K | $47.95 | 3.22x |
| 36415 | Venipuncture for blood draw | 548 | $26.3K | $47.95 | 3.06x |
This provider submits charges 3.68 times higher than what Medicare actually pays.
A markup ratio of 3.68x means for every $100 Medicare pays, this provider initially charges $368. 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.
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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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