Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 87.9% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #289 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 $468.8K in total Medicare payments ranks in the 95th percentile of Emergency Medicine providers nationally.
Medicare payments to this provider grew 125% 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 | 2.0K | $100.5K | $49.65 | 2.87x |
| 99214 | Office visit, established patient, moderate complexity | 1.8K | $90.5K | $49.66 | 2.46x |
| 99215 | Office visit, established patient, high complexity | 1.6K | $80.4K | $49.65 | 2.80x |
| 99232 | Subsequent hospital care, moderate complexity | 1.4K | $70.4K | $49.67 | 2.10x |
| 99233 | Subsequent hospital care, high complexity | 1.2K | $60.3K | $49.65 | 2.92x |
| 93000 | Electrocardiogram, complete | 1.0K | $50.3K | $49.67 | 2.26x |
| 71046 | Chest X-ray, 2 views | 810 | $40.2K | $49.65 | 2.81x |
| 80053 | Comprehensive metabolic panel | 607 | $30.2K | $49.69 | 2.44x |
| 85025 | Complete blood count with differential | 405 | $20.1K | $49.65 | 2.70x |
| 36415 | Venipuncture for blood draw | 202 | $10.1K | $49.77 | 2.36x |
This provider submits charges 2.48 times higher than what Medicare actually pays.
A markup ratio of 2.48x means for every $100 Medicare pays, this provider initially charges $248. 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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