Statistical flag only — not an accusation of fraud
This provider's $1.9M in total Medicare payments ranks in the 91th percentile of Hematology-Oncology providers nationally.
Their average markup ratio of 24.91x is significantly above the specialty median of 3.5x.
Medicare payments to this provider grew 77% from 2014 to 2023.
This provider has been statistically flagged with a risk score of 69/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
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 |
|---|---|---|---|---|---|---|---|
| 2014 | $386.35 | $15.51 | 24.91x | $370.84 | $135.3K | 8.7K | 369 |
| 2015 | $386.35 | $15.51 | 24.91x | $370.84 | $146.9K | 9.5K | 400 |
| 2016 | $386.35 | $15.51 | 24.91x | $370.84 | $158.5K | 10.2K | 432 |
| 2017 | $386.35 | $15.51 | 24.91x | $370.84 | $170.1K | 11.0K | 463 |
| 2018 | $386.35 | $15.51 | 24.91x | $370.84 | $181.7K | 11.7K | 495 |
| 2019 | $386.35 | $15.51 | 24.91x | $370.84 | $193.3K | 12.5K | 527 |
| 2020 | $386.35 | $15.51 | 24.91x | $370.84 | $204.9K | 13.2K | 558 |
| 2021 | $386.35 | $15.51 | 24.91x | $370.84 | $216.5K | 14.0K | 590 |
| 2022 | $386.35 | $15.51 | 24.91x | $370.84 | $228.1K | 14.7K | 622 |
| 2023 | $386.35 | $15.51 | 24.91x | $370.84 | $239.7K | 15.5K | 653 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99213 | Office/outpatient visit, est patient, low | 42.6K | $660.1K | $15.51 | 23.51x |
| 99214 | Office/outpatient visit, est patient, moderate | 21.3K | $330.0K | $15.51 | 29.48x |
| 99215 | Office/outpatient visit, est patient, high | 14.2K | $220.0K | $15.51 | 23.16x |
| 99223 | Initial hospital care, high complexity | 10.6K | $165.0K | $15.51 | 27.63x |
| 99232 | Subsequent hospital care, moderate | 8.5K | $132.0K | $15.51 | 20.45x |
| 93000 | Electrocardiogram, complete | 7.1K | $110.0K | $15.51 | 28.84x |
| 71046 | Chest X-ray, 2 views | 6.1K | $94.3K | $15.51 | 20.39x |
| 80053 | Comprehensive metabolic panel | 5.3K | $82.5K | $15.51 | 28.69x |
| 85025 | Complete blood count (CBC) | 4.7K | $73.3K | $15.51 | 21.71x |
| 36415 | Venipuncture | 4.3K | $66.0K | $15.51 | 26.02x |
This provider submits charges 24.91 times higher than what Medicare actually pays.
A markup ratio of 24.91x means for every $100 Medicare pays, this provider initially charges $2491. 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 VA for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Thomas Alberico, MD | Norfolk, VA | $38.5M | ⚠️ Flagged |
| Mark Fleming, MD | Hampton, VA | $37.6M | ⚠️ 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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