Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 89.2% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #311 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 99th percentile of Nurse Practitioner 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 | 5.6K | $335.9K | $60.40 | 2.28x |
| 99214 | Office visit, established patient, moderate complexity | 5.0K | $302.3K | $60.40 | 1.88x |
| 99215 | Office visit, established patient, high complexity | 4.4K | $268.7K | $60.39 | 2.03x |
| 99232 | Subsequent hospital care, moderate complexity | 3.9K | $235.1K | $60.39 | 2.29x |
| 99233 | Subsequent hospital care, high complexity | 3.3K | $201.5K | $60.39 | 2.07x |
| 93000 | Electrocardiogram, complete | 2.8K | $167.9K | $60.39 | 2.02x |
| 71046 | Chest X-ray, 2 views | 2.2K | $134.3K | $60.38 | 1.80x |
| 80053 | Comprehensive metabolic panel | 1.7K | $100.8K | $60.41 | 2.19x |
| 85025 | Complete blood count with differential | 1.1K | $67.2K | $60.41 | 2.02x |
| 36415 | Venipuncture for blood draw | 556 | $33.6K | $60.41 | 2.09x |
This provider submits charges 2.08 times higher than what Medicare actually pays.
A markup ratio of 2.08x means for every $100 Medicare pays, this provider initially charges $208. This is higher 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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