Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 86.3% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #473 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 $339.6K in total Medicare payments ranks in the 93th percentile of Emergency Medicine providers nationally.
Medicare payments to this provider grew 95% 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 | 1.2K | $71.8K | $61.13 | 3.40x |
| 99214 | Office visit, established patient, moderate complexity | 1.1K | $64.6K | $61.17 | 2.50x |
| 99215 | Office visit, established patient, high complexity | 939 | $57.4K | $61.14 | 3.10x |
| 99232 | Subsequent hospital care, moderate complexity | 822 | $50.2K | $61.12 | 2.29x |
| 99233 | Subsequent hospital care, high complexity | 704 | $43.1K | $61.16 | 3.03x |
| 93000 | Electrocardiogram, complete | 587 | $35.9K | $61.13 | 2.99x |
| 71046 | Chest X-ray, 2 views | 469 | $28.7K | $61.21 | 2.59x |
| 80053 | Comprehensive metabolic panel | 352 | $21.5K | $61.16 | 3.38x |
| 85025 | Complete blood count with differential | 235 | $14.4K | $61.08 | 3.20x |
| 36415 | Venipuncture for blood draw | 117 | $7.2K | $61.34 | 2.88x |
This provider submits charges 2.86 times higher than what Medicare actually pays.
A markup ratio of 2.86x means for every $100 Medicare pays, this provider initially charges $286. 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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