Statistical flag only — not an accusation of fraud
This provider's $36.5M in total Medicare payments ranks in the 97th percentile of Clinical Laboratory providers nationally.
Medicare payments to this provider grew 4090% from 2019 to 2023.
77% of their billing comes from a single procedure code (K1034 — Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count).
This provider has been statistically flagged with a risk score of 68/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 1838% in 2023
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 |
|---|---|---|---|---|---|---|---|
| 2019 | $444.08 | $145.59 | 3.05x | $298.49 | $662.2K | 4.5K | 4 |
| 2020 | $355.80 | $128.58 | 2.77x | $227.22 | $1.2M | 9.4K | 26 |
| 2021 | $205.01 | $125.19 | 1.64x | $79.82 | $5.5M | 44.0K | 66 |
| 2022 | $176.18 | $71.59 | 2.46x | $104.59 | $1.4M | 20.0K | 13 |
| 2023 | $12.55 | $11.93 | 1.05x | $0.62 | $27.7M | 2.3M | 4 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| K1034 | Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count | 2.3M | $27.3M | $11.76 | 1.02x |
| G0483 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms | 12.5K | $3.0M | $244.36 | 3.04x |
| 81408 | Molecular pathology procedure level 9 | 744 | $1.5M | $2.0K | 1.03x |
| 80307 | Testing for presence of drug, by chemistry analyzers | 12.2K | $752.5K | $61.92 | 3.07x |
| 87798 | Detection test by nucleic acid for organism, amplified probe technique | 20.6K | $719.9K | $35.00 | 1.31x |
| 81404 | Molecular pathology procedure level 5 | 1.4K | $383.7K | $274.83 | 1.01x |
| 81407 | Molecular pathology procedure level 8 | 286 | $242.0K | $846.27 | 1.02x |
| 81406 | Molecular pathology procedure level 7 | 751 | $212.4K | $282.86 | 2.90x |
| 81405 | Molecular pathology procedure level 6 | 622 | $187.4K | $301.35 | 1.02x |
| G0481 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms | 1.0K | $157.6K | $155.60 | 3.02x |
| 81439 | Test for detecting genes associated with inherited disease of heart muscle | 240 | $140.1K | $583.78 | 1.01x |
| U0003 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r | 1.7K | $127.9K | $75.00 | 3.00x |
| 81249 | Gene analysis (glucose-6-phosphate dehydrogenase) full sequence analysis | 203 | $119.2K | $586.95 | 1.02x |
| 87481 | Detection test for candida species (yeast), amplified probe technique | 2.5K | $86.1K | $35.14 | 2.55x |
| 81306 | Gene analysis (nudix hydrolase 15) for common variants | 283 | $82.5K | $291.36 | 1.03x |
| 81350 | Gene analysis (udp glucuronosyltransferase 1 family, polypeptide a1) for detection of common variants | 329 | $77.0K | $233.99 | 1.10x |
| 81401 | Molecular pathology procedure level 2 | 552 | $75.6K | $136.99 | 1.12x |
| 87426 | Detection test by immunoassay technique for severe acute respiratory syndrome coronavirus | 1.4K | $64.2K | $45.01 | 3.00x |
| 81223 | Gene analysis (cystic fibrosis transmembrane conductance regular) full gene sequence | 129 | $64.0K | $495.96 | 1.04x |
| 81286 | Gene analysis (frataxin) of full sequence | 224 | $61.6K | $274.83 | 1.01x |
This provider submits charges 1.29 times higher than what Medicare actually pays.
A markup ratio of 1.29x means for every $100 Medicare pays, this provider initially charges $129. This is lower 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.
Other Clinical Laboratory providers in TX for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Clinical Pathology Laboratories, Inc. | Austin, TX | $541.0M | ⚠️ Flagged |
| Quest Diagnostics Clinical Laboratories Inc | Irving, TX | $453.2M | ⚠️ Flagged |
| Laboratory Corporation Of America | Dallas, TX | $389.6M | ⚠️ Flagged |
| Quest Diagnostics Clinical Laboratories Inc | Houston, TX | $311.2M | ⚠️ Flagged |
| Laboratory Corporation Of America | Houston, TX | $299.4M | ⚠️ Flagged |
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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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