Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 93.7% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #50 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 $1.4M in total Medicare payments ranks in the 88th percentile of Hematology-Oncology providers nationally.
Medicare payments to this provider grew 105% 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 | 5.8K | $300.4K | $52.19 | 2.78x |
| 99214 | Office visit, established patient, moderate complexity | 5.2K | $270.4K | $52.19 | 2.86x |
| 99215 | Office visit, established patient, high complexity | 4.6K | $240.3K | $52.19 | 2.26x |
| 99232 | Subsequent hospital care, moderate complexity | 4.0K | $210.3K | $52.19 | 2.63x |
| 99233 | Subsequent hospital care, high complexity | 3.5K | $180.2K | $52.20 | 2.68x |
| 93000 | Electrocardiogram, complete | 2.9K | $150.2K | $52.19 | 2.17x |
| 71046 | Chest X-ray, 2 views | 2.3K | $120.2K | $52.20 | 2.40x |
| 80053 | Comprehensive metabolic panel | 1.7K | $90.1K | $52.18 | 1.95x |
| 85025 | Complete blood count with differential | 1.2K | $60.1K | $52.20 | 2.43x |
| 36415 | Venipuncture for blood draw | 576 | $30.0K | $52.15 | 2.75x |
This provider submits charges 2.39 times higher than what Medicare actually pays.
A markup ratio of 2.39x means for every $100 Medicare pays, this provider initially charges $239. 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 NJ for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Bhavesh Balar, MD | Freehold, NJ | $36.9M | ⚠️ 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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