Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 93.0% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #80 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 $231.9K in total Medicare payments ranks in the 82th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 98% 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 | 897 | $49.6K | $55.29 | 1.91x |
| 99214 | Office visit, established patient, moderate complexity | 807 | $44.6K | $55.31 | 2.18x |
| 99215 | Office visit, established patient, high complexity | 718 | $39.7K | $55.26 | 1.96x |
| 99232 | Subsequent hospital care, moderate complexity | 628 | $34.7K | $55.28 | 2.35x |
| 99233 | Subsequent hospital care, high complexity | 538 | $29.8K | $55.31 | 2.28x |
| 93000 | Electrocardiogram, complete | 448 | $24.8K | $55.35 | 2.01x |
| 71046 | Chest X-ray, 2 views | 359 | $19.8K | $55.26 | 1.80x |
| 80053 | Comprehensive metabolic panel | 269 | $14.9K | $55.31 | 1.76x |
| 85025 | Complete blood count with differential | 179 | $9.9K | $55.41 | 1.73x |
| 36415 | Venipuncture for blood draw | 90 | $5.0K | $55.11 | 1.86x |
This provider submits charges 2.05 times higher than what Medicare actually pays.
A markup ratio of 2.05x means for every $100 Medicare pays, this provider initially charges $205. 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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