Statistical flag only — not an accusation of fraud
⚠️ This provider averages 1.3K services per working day — physically unusual for an individual practitioner
Based on 3.2M total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $29.8M in total Medicare payments ranks in the 99th percentile of Hematology-Oncology providers nationally.
Their average markup ratio of 5.07x is significantly above the specialty median of 3.5x.
Averaging 1.3K services per working day raises questions about billing patterns.
Medicare payments to this provider grew 153% from 2014 to 2023.
This provider has been statistically flagged with a risk score of 75/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 74% in 2016
Year-over-year payment surges can indicate changes in practice volume, new services, or billing pattern shifts.
Average per-service amounts submitted by the provider compared to what Medicare actually paid — the gap represents the markup.
| Year | Avg Submitted | Avg Paid | Markup Ratio | Gap per Service | Total Payments | Services | Beneficiaries |
|---|---|---|---|---|---|---|---|
| 2014 | $52.70 | $10.65 | 4.95x | $42.05 | $1.7M | 155.9K | 59 |
| 2015 | $45.50 | $8.80 | 5.17x | $36.70 | $1.3M | 149.8K | 56 |
| 2016 | $40.23 | $8.26 | 4.87x | $31.97 | $2.3M | 277.5K | 56 |
| 2017 | $46.41 | $9.02 | 5.15x | $37.39 | $2.6M | 283.6K | 61 |
| 2018 | $42.89 | $8.61 | 4.98x | $34.28 | $3.1M | 356.4K | 61 |
| 2019 | $46.60 | $9.20 | 5.07x | $37.40 | $4.6M | 504.6K | 67 |
| 2020 | $47.68 | $8.40 | 5.68x | $39.28 | $3.2M | 382.2K | 65 |
| 2021 | $48.83 | $9.55 | 5.11x | $39.28 | $3.2M | 332.0K | 60 |
| 2022 | $47.11 | $9.86 | 4.78x | $37.25 | $3.7M | 372.7K | 64 |
| 2023 | $57.56 | $11.58 | 4.97x | $45.98 | $4.2M | 362.5K | 68 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J9271 | Injection, pembrolizumab, 1 mg | 130.5K | $5.3M | $40.26 | 3.34x |
| 78815 | Nuclear medicine study from skull base to mid-thigh with ct scan | 1.6K | $2.0M | $1.2K | 3.37x |
| J2505 | Injection, pegfilgrastim, 6 mg | 617 | $1.9M | $3.1K | 4.74x |
| J9305 | Injection, pemetrexed, not otherwise specified, 10 mg | 31.9K | $1.6M | $50.71 | 3.79x |
| J9144 | Injection, daratumumab, 10 mg and hyaluronidase-fihj | 40.5K | $1.5M | $36.40 | 3.65x |
| J0881 | Injection, darbepoetin alfa, 1 microgram (non-esrd use) | 507.9K | $1.4M | $2.85 | 7.19x |
| J1568 | Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg | 43.8K | $1.3M | $30.27 | 7.25x |
| J9310 | Injection, rituximab, 100 mg | 1.8K | $1.1M | $615.12 | 3.47x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 18.8K | $1.1M | $56.64 | 2.61x |
| J0897 | Injection, denosumab, 1 mg | 67.9K | $986.9K | $14.54 | 3.71x |
| J9145 | Injection, daratumumab, 10 mg | 17.8K | $773.7K | $43.47 | 3.43x |
| J9035 | Injection, bevacizumab, 10 mg | 13.0K | $766.1K | $59.00 | 3.53x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 6.6K | $738.5K | $111.68 | 6.14x |
| J9041 | Injection, bortezomib, 0.1 mg | 22.1K | $557.6K | $25.27 | 4.90x |
| J9299 | Injection, nivolumab, 1 mg | 22.9K | $502.9K | $21.97 | 3.43x |
| A9552 | Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries | 1.7K | $394.5K | $232.62 | 2.74x |
| J9355 | Injection, trastuzumab, 10 mg | 4.4K | $364.6K | $82.96 | 3.39x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 3.8K | $319.8K | $83.13 | 2.69x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 2.2K | $271.0K | $120.87 | 2.84x |
| J2469 | Injection, palonosetron hcl, 25 mcg | 30.1K | $270.7K | $8.99 | 13.33x |
This provider submits charges 5.07 times higher than what Medicare actually pays.
A markup ratio of 5.07x means for every $100 Medicare pays, this provider initially charges $507. 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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