Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 89.2% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #235 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 $1.3M in total Medicare payments ranks in the 98th percentile of General Practice providers nationally.
Medicare payments to this provider grew 100% 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 | 6.1K | $285.5K | $47.07 | 2.33x |
| 99214 | Office visit, established patient, moderate complexity | 5.5K | $256.9K | $47.08 | 2.07x |
| 99215 | Office visit, established patient, high complexity | 4.9K | $228.4K | $47.07 | 2.19x |
| 99232 | Subsequent hospital care, moderate complexity | 4.2K | $199.8K | $47.08 | 2.89x |
| 99233 | Subsequent hospital care, high complexity | 3.6K | $171.3K | $47.07 | 2.18x |
| 93000 | Electrocardiogram, complete | 3.0K | $142.7K | $47.08 | 2.81x |
| 71046 | Chest X-ray, 2 views | 2.4K | $114.2K | $47.07 | 2.04x |
| 80053 | Comprehensive metabolic panel | 1.8K | $85.6K | $47.08 | 2.84x |
| 85025 | Complete blood count with differential | 1.2K | $57.1K | $47.07 | 1.99x |
| 36415 | Venipuncture for blood draw | 606 | $28.5K | $47.11 | 2.09x |
This provider submits charges 2.44 times higher than what Medicare actually pays.
A markup ratio of 2.44x means for every $100 Medicare pays, this provider initially charges $244. 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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