Statistical flag only — not an accusation of fraud
⚠️ This provider averages 2.2K services per working day — physically unusual for an individual practitioner
Based on 1.1M total services over 2 years (250 working days/year). Learn about impossible service volumes →
This provider's $7.8M in total Medicare payments ranks in the 99th percentile of Nurse Practitioner providers nationally.
Averaging 2.2K services per working day raises questions about billing patterns.
Medicare payments to this provider grew 267% from 2022 to 2023.
This provider has been statistically flagged with a risk score of 85/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 267% in 2023
Year-over-year payment surges can indicate changes in practice volume, new services, or billing pattern shifts.
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 |
|---|---|---|---|---|---|---|---|
| 2022 | $24.04 | $7.94 | 3.03x | $16.10 | $1.7M | 211.7K | 31 |
| 2023 | $20.05 | $6.99 | 2.87x | $13.06 | $6.2M | 882.5K | 40 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0897 | Injection, denosumab, 1 mg | 104.8K | $1.9M | $18.15 | 1.93x |
| J9271 | Injection, pembrolizumab, 1 mg | 40.9K | $1.8M | $42.98 | 2.16x |
| J3380 | Injection, vedolizumab, 1 mg | 44.4K | $771.0K | $17.36 | 2.02x |
| J1602 | Injection, golimumab, 1 mg, for intravenous use | 56.6K | $604.3K | $10.67 | 6.84x |
| J9299 | Injection, nivolumab, 1 mg | 24.3K | $575.0K | $23.66 | 2.11x |
| J1439 | Injection, ferric carboxymaltose, 1 mg | 641.3K | $562.0K | $0.88 | 2.28x |
| J3111 | Injection, romosozumab-aqqg, 1 mg | 67.2K | $531.8K | $7.91 | 2.27x |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 10.0K | $266.5K | $26.65 | 6.19x |
| J0129 | Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered) | 6.4K | $215.8K | $33.72 | 1.96x |
| J0881 | Injection, darbepoetin alfa, 1 microgram (non-esrd use) | 53.7K | $127.8K | $2.38 | 5.88x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 1.5K | $115.6K | $78.78 | 3.92x |
| 96365 | Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less | 2.0K | $75.7K | $37.96 | 4.32x |
| J9217 | Leuprolide acetate (for depot suspension), 7.5 mg | 462 | $62.5K | $135.19 | 7.38x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 810 | $45.4K | $56.05 | 2.48x |
| J1454 | Injection, fosnetupitant 235 mg and palonosetron 0.25 mg | 130 | $45.4K | $349.06 | 3.98x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 561 | $44.7K | $79.66 | 2.34x |
| 96372 | Injection of drug or substance under skin or into muscle | 2.9K | $24.0K | $8.27 | 6.16x |
| 96367 | Infusion into a vein for therapy, prevention, or diagnosis, additional sequential infusion, 1 hour or less | 1.1K | $19.3K | $18.04 | 4.99x |
| 96415 | Administration of chemotherapy into vein, each additional hour | 741 | $12.7K | $17.20 | 11.40x |
| G0498 | Chemotherapy administration, intravenous infusion technique; initiation of infusion in the office/clinic setting using office/clinic pump/supplies, with continuation of the infusion in the community setting (e.g., home, domiciliary, rest home or assisted l | 101 | $9.9K | $97.94 | 3.17x |
This provider submits charges 2.9 times higher than what Medicare actually pays.
A markup ratio of 2.9x means for every $100 Medicare pays, this provider initially charges $290. 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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