Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 91.3% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #102 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 $1.6M in total Medicare payments ranks in the 97th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 97% 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 | 4.8K | $334.6K | $69.26 | 2.12x |
| 99214 | Office visit, established patient, moderate complexity | 4.3K | $301.2K | $69.28 | 1.54x |
| 99215 | Office visit, established patient, high complexity | 3.9K | $267.7K | $69.28 | 2.05x |
| 99232 | Subsequent hospital care, moderate complexity | 3.4K | $234.2K | $69.28 | 2.12x |
| 99233 | Subsequent hospital care, high complexity | 2.9K | $200.8K | $69.28 | 2.13x |
| 93000 | Electrocardiogram, complete | 2.4K | $167.3K | $69.28 | 2.06x |
| 71046 | Chest X-ray, 2 views | 1.9K | $133.8K | $69.28 | 2.00x |
| 80053 | Comprehensive metabolic panel | 1.4K | $100.4K | $69.28 | 1.84x |
| 85025 | Complete blood count with differential | 966 | $66.9K | $69.28 | 2.05x |
| 36415 | Venipuncture for blood draw | 483 | $33.5K | $69.28 | 1.56x |
This provider submits charges 1.79 times higher than what Medicare actually pays.
A markup ratio of 1.79x means for every $100 Medicare pays, this provider initially charges $179. This is lower 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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