Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 86.0% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #489 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 $284.6K in total Medicare payments ranks in the 85th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 119% 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 | 1.3K | $60.8K | $47.29 | 1.53x |
| 99214 | Office visit, established patient, moderate complexity | 1.2K | $54.7K | $47.27 | 1.56x |
| 99215 | Office visit, established patient, high complexity | 1.0K | $48.6K | $47.29 | 1.71x |
| 99232 | Subsequent hospital care, moderate complexity | 900 | $42.5K | $47.27 | 1.26x |
| 99233 | Subsequent hospital care, high complexity | 771 | $36.5K | $47.29 | 1.43x |
| 93000 | Electrocardiogram, complete | 643 | $30.4K | $47.26 | 1.63x |
| 71046 | Chest X-ray, 2 views | 514 | $24.3K | $47.29 | 1.78x |
| 80053 | Comprehensive metabolic panel | 386 | $18.2K | $47.23 | 1.31x |
| 85025 | Complete blood count with differential | 257 | $12.2K | $47.30 | 1.29x |
| 36415 | Venipuncture for blood draw | 129 | $6.1K | $47.11 | 1.44x |
This provider submits charges 1.5 times higher than what Medicare actually pays.
A markup ratio of 1.5x means for every $100 Medicare pays, this provider initially charges $150. 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.
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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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