Statistical flag only — not an accusation of fraud
This provider's $9.4M in total Medicare payments ranks in the 90th percentile of Clinical Laboratory providers nationally.
Their average markup ratio of 7.63x is significantly above the specialty median of 3.7x.
Medicare payments to this provider grew 159003% from 2022 to 2023.
75% of their billing comes from a single procedure code (87811 — Detection test by immunoassay with direct visual observation for severe acute respiratory syndrome coronavirus 2 (covid-19)).
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 159003% 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 | $118.58 | $26.95 | 4.40x | $91.63 | $5.9K | 218 | 3 |
| 2023 | $325.00 | $42.58 | 7.63x | $282.42 | $9.3M | 219.5K | 2 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 87811 | Detection test by immunoassay with direct visual observation for severe acute respiratory syndrome coronavirus 2 (covid-19) | 173.6K | $7.0M | $40.55 | 8.01x |
| 87635 | Amplifed dna or rna probe detection of severe acute respiratory syndrome coronavirus 2 (covid-19) antigen | 45.9K | $2.3M | $50.28 | 6.46x |
| G2023 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source | 180 | $4.2K | $23.16 | 3.24x |
This provider submits charges 7.63 times higher than what Medicare actually pays.
A markup ratio of 7.63x means for every $100 Medicare pays, this provider initially charges $763. 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 Clinical Laboratory providers in NY for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Northwell Health Laboratories | New Hyde Park, NY | $299.4M | ⚠️ Flagged |
| Sunrise Medical Laboratories, Inc. | Hicksville, NY | $281.2M | ⚠️ Flagged |
| Lenco Diagnostic Laboratories,inc. | Brooklyn, NY | $101.5M | ⚠️ Flagged |
| Enzo Clinical Labs, Inc. | Farmingdale, NY | $100.1M | ⚠️ Flagged |
| Cblpath, Inc | Rye Brook, NY | $94.4M | ✓ Clear |
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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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