Statistical flag only — not an accusation of fraud
This provider's $1.8M in total Medicare payments ranks in the 99th percentile of Family Practice providers nationally.
Their average markup ratio of 58.51x is significantly above the specialty median of 2.8x.
This provider has been statistically flagged with a risk score of 80/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
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 |
|---|---|---|---|---|---|---|---|
| 2014 | $68.14 | $25.79 | 2.64x | $42.35 | $112.3K | 4.4K | 554 |
| 2015 | $55.75 | $25.79 | 2.16x | $29.96 | $134.4K | 5.2K | 663 |
| 2016 | $88.15 | $25.79 | 3.42x | $62.36 | $109.7K | 4.3K | 541 |
| 2017 | $74.17 | $25.79 | 2.88x | $48.38 | $120.3K | 4.7K | 593 |
| 2018 | $83.39 | $25.79 | 3.23x | $57.60 | $139.8K | 5.4K | 690 |
| 2019 | $89.75 | $25.79 | 3.48x | $63.96 | $131.5K | 5.1K | 648 |
| 2020 | $59.68 | $25.79 | 2.31x | $33.89 | $152.0K | 5.9K | 750 |
| 2021 | $69.08 | $25.79 | 2.68x | $43.29 | $160.3K | 6.2K | 791 |
| 2022 | $56.89 | $25.79 | 2.21x | $31.10 | $185.1K | 7.2K | 913 |
| 2023 | $86.84 | $25.79 | 3.37x | $61.05 | $158.6K | 6.2K | 782 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office visit, 30-39 min | 18.7K | $481.8K | $25.79 | 3.38x |
| 99213 | Established patient office visit, 20-29 min | 5.7K | $146.3K | $25.79 | 4.89x |
| 99215 | Established patient office visit, 40-54 min | 4.1K | $106.2K | $25.79 | 4.70x |
| 99232 | Subsequent hospital care, moderate complexity | 1.6K | $41.4K | $25.78 | 2.17x |
| 99223 | Initial hospital care, high complexity | 2.3K | $58.7K | $25.79 | 5.31x |
| G0463 | Hospital outpatient clinic visit | 4.8K | $123.2K | $25.79 | 5.55x |
| 99212 | Established patient office visit, 10-19 min | 1.8K | $46.7K | $25.79 | 5.84x |
| 93000 | Electrocardiogram, complete | 2.0K | $50.7K | $25.79 | 3.30x |
| 36415 | Venipuncture | 3.2K | $82.1K | $25.79 | 5.42x |
| 96372 | Therapeutic injection, subcutaneous or IM | 1.9K | $48.2K | $25.78 | 5.58x |
This provider submits charges 58.51 times higher than what Medicare actually pays.
A markup ratio of 58.51x means for every $100 Medicare pays, this provider initially charges $5851. 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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