Statistical flag only — not an accusation of fraud
This provider's $31.5M in total Medicare payments ranks in the 97th percentile of Clinical Laboratory providers nationally.
Medicare payments to this provider grew 562851% from 2022 to 2023.
100% of their billing comes from a single procedure code (K1034 — Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count).
This provider has been statistically flagged with a risk score of 68/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 562851% 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 | $100.00 | $49.15 | 2.03x | $50.85 | $5.6K | 114 | 1 |
| 2023 | $15.56 | $11.76 | 1.32x | $3.80 | $31.5M | 2.7M | 1 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| K1034 | Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count | 2.7M | $31.5M | $11.76 | 1.32x |
| U0003 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r | 57 | $4.2K | $73.72 | 2.03x |
| U0005 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within | 57 | $1.4K | $24.57 | 2.03x |
This provider submits charges 1.32 times higher than what Medicare actually pays.
A markup ratio of 1.32x means for every $100 Medicare pays, this provider initially charges $132. This is lower 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 Clinical Laboratory providers in TX for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Clinical Pathology Laboratories, Inc. | Austin, TX | $541.0M | ⚠️ Flagged |
| Quest Diagnostics Clinical Laboratories Inc | Irving, TX | $453.2M | ⚠️ Flagged |
| Laboratory Corporation Of America | Dallas, TX | $389.6M | ⚠️ Flagged |
| Quest Diagnostics Clinical Laboratories Inc | Houston, TX | $311.2M | ⚠️ Flagged |
| Laboratory Corporation Of America | Houston, TX | $299.4M | ⚠️ 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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