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Data Sources: Centers for Medicare & Medicaid Services (CMS), Medicare Provider Utilization and Payment Data
Disclaimer: This site is an independent journalism project. Data analysis and editorial content are not affiliated with or endorsed by CMS or any government agency. All spending figures are based on publicly available Medicare payment records.
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Methodology•Download Data
  1. Home
  2. Providers
  3. Michael Scoma
⚕️
MDIndividual

Michael Scoma, M.D.

NPI: 1215167390
Mineola, NY
10 years of data
Infectious Disease
$5.1M
Total Payments
17.7K
Beneficiaries
68.5K
Services
2.99x
Markup Ratio

Peer Comparison

99th
percentile in specialty
This provider$5.1M
Specialty median$93.3K

📋 Key Findings

1Billed $5.1M over 10 years
22.99x markup ratio (above median)
399th percentile in Infectious Disease by payments
4Payments surged 65% in 2016
53 procedures with >3x markup
✓ No flags detected

🔎 Data Analysis

This provider's $5.1M in total Medicare payments ranks in the 99th percentile of Infectious Disease providers nationally.

Medicare payments to this provider grew 301% from 2014 to 2023.

70% of their billing comes from a single procedure code (99232 — Subsequent hospital inpatient care, typically 25 minutes per day).

AI-generated analysis based on Medicare payment data.

Annual Medicare Payments

Annual Services Provided

Avg Payment per Service

Markup Ratio Over Time

📈

Notable: Payments increased 65% in 2016

Year-over-year payment surges can indicate changes in practice volume, new services, or billing pattern shifts.

Submitted Charges vs. Medicare Payments

Average per-service amounts submitted by the provider compared to what Medicare actually paid — the gap represents the markup.

YearAvg SubmittedAvg PaidMarkup RatioGap per ServiceTotal PaymentsServicesBeneficiaries
2014$226.27$97.082.33x$129.19$184.8K2.5K1.6K
2015$221.13$101.032.19x$120.10$246.9K3.0K1.9K
2016$237.57$95.012.50x$142.56$407.1K5.6K1.9K
2017$333.42$92.753.59x$240.67$579.7K8.1K1.8K
2018$528.45$91.575.77x$436.88$576.7K8.0K1.8K
2019$290.29$94.083.09x$196.21$508.0K6.9K1.5K
2020$547.86$91.026.02x$456.84$520.2K6.9K1.4K
2021$321.98$103.333.12x$218.65$685.9K9.1K1.9K
2022$305.17$102.192.99x$202.98$661.7K9.0K2.0K
2023$596.58$100.415.94x$496.17$741.5K9.4K2.0K

Top Procedures (9)

99232Subsequent hospital inpatient care, typically 25 minutes per day
$3.6M
53.9K services$66.86/svc2.92x markup
99222Initial hospital inpatient care, typically 50 minutes per day
$929.6K
7.5K services$124.00/svc2.96x markup
99233Subsequent hospital inpatient care, typically 35 minutes per day⚠ 4.6x markup
$219.2K
2.4K services$92.83/svc4.58x markup
99223Initial hospital inpatient care, typically 70 minutes per day
$201.5K
1.1K services$181.51/svc1.94x markup
99231Subsequent hospital inpatient care, typically 15 minutes per day⚠ 4.5x markup
$110.0K
3.2K services$34.83/svc4.46x markup
99214Established patient office or other outpatient, visit typically 25 minutes
$42.3K
427 services$98.96/svc2.74x markup
99204New patient office or other outpatient visit, typically 45 minutes
$3.6K
24 services$148.19/svc2.42x markup
99213Established patient office or other outpatient visit, typically 15 minutes
$3.5K
53 services$66.45/svc2.35x markup
99221Initial hospital inpatient care, typically 30 minutes per day⚠ 3.1x markup
$1.2K
13 services$91.08/svc3.12x markup
Show detailed table ▾
CodeDescriptionServicesPaymentsAvg/ServiceMarkup
99232Subsequent hospital inpatient care, typically 25 minutes per day53.9K$3.6M$66.862.92x
99222Initial hospital inpatient care, typically 50 minutes per day7.5K$929.6K$124.002.96x
99233Subsequent hospital inpatient care, typically 35 minutes per day2.4K$219.2K$92.834.58x
99223Initial hospital inpatient care, typically 70 minutes per day1.1K$201.5K$181.511.94x
99231Subsequent hospital inpatient care, typically 15 minutes per day3.2K$110.0K$34.834.46x
99214Established patient office or other outpatient, visit typically 25 minutes427$42.3K$98.962.74x
99204New patient office or other outpatient visit, typically 45 minutes24$3.6K$148.192.42x
99213Established patient office or other outpatient visit, typically 15 minutes53$3.5K$66.452.35x
99221Initial hospital inpatient care, typically 30 minutes per day13$1.2K$91.083.12x

Markup Analysis

Charge-to-Payment Ratio

2.99x

This provider submits charges 2.99 times higher than what Medicare actually pays.

What This Means

A markup ratio of 2.99x means for every $100 Medicare pays, this provider initially charges $299. This is higher than the national average.

Location

Mineola, NY

Provider Verification

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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Data Sources

  • • Centers for Medicare & Medicaid Services (CMS)
  • • Medicare Provider Utilization and Payment Data (2014-2023)
  • • National Plan and Provider Enumeration System (NPPES)

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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