Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 89.7% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #242 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 $108.7K in total Medicare payments ranks in the 75th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 105% 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 | 405 | $23.6K | $58.31 | 1.66x |
| 99214 | Office visit, established patient, moderate complexity | 365 | $21.3K | $58.23 | 1.53x |
| 99215 | Office visit, established patient, high complexity | 324 | $18.9K | $58.31 | 1.88x |
| 99395 | Preventive visit, 18-39 years | 284 | $16.5K | $58.21 | 1.65x |
| 99396 | Preventive visit, 40-64 years | 243 | $14.2K | $58.31 | 1.63x |
| 93000 | Electrocardiogram, complete | 203 | $11.8K | $58.17 | 2.04x |
| 71046 | Chest X-ray, 2 views | 162 | $9.4K | $58.31 | 1.50x |
| 80053 | Comprehensive metabolic panel | 122 | $7.1K | $58.07 | 1.53x |
| 85025 | Complete blood count with differential | 81 | $4.7K | $58.31 | 1.44x |
| 36415 | Venipuncture for blood draw | 41 | $2.4K | $57.61 | 1.39x |
This provider submits charges 1.73 times higher than what Medicare actually pays.
A markup ratio of 1.73x means for every $100 Medicare pays, this provider initially charges $173. 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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