Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 86.2% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #497 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 $1.3M in total Medicare payments ranks in the 97th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 123% 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 | 6.6K | $277.3K | $41.72 | 2.51x |
| 99214 | Office visit, established patient, moderate complexity | 6.0K | $249.6K | $41.73 | 2.17x |
| 99215 | Office visit, established patient, high complexity | 5.3K | $221.9K | $41.72 | 2.33x |
| 99232 | Subsequent hospital care, moderate complexity | 4.7K | $194.1K | $41.72 | 2.50x |
| 99233 | Subsequent hospital care, high complexity | 4.0K | $166.4K | $41.72 | 2.29x |
| 93000 | Electrocardiogram, complete | 3.3K | $138.7K | $41.72 | 2.74x |
| 71046 | Chest X-ray, 2 views | 2.7K | $110.9K | $41.72 | 2.56x |
| 80053 | Comprehensive metabolic panel | 2.0K | $83.2K | $41.73 | 2.77x |
| 85025 | Complete blood count with differential | 1.3K | $55.5K | $41.74 | 2.72x |
| 36415 | Venipuncture for blood draw | 665 | $27.7K | $41.70 | 2.77x |
This provider submits charges 2.67 times higher than what Medicare actually pays.
A markup ratio of 2.67x means for every $100 Medicare pays, this provider initially charges $267. 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.
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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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