Statistical flag only — not an accusation of fraud
⚠️ This provider averages 552 services per working day — physically unusual for an individual practitioner
Based on 689.4K total services over 5 years (250 working days/year). Learn about impossible service volumes →
This provider's $9.8M in total Medicare payments ranks in the 98th percentile of Hematology-Oncology providers nationally.
Averaging 552 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 1249% from 2019 to 2023.
This provider has been statistically flagged with a risk score of 66/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 910% in 2020
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 | $28.49 | $5.17 | 5.51x | $23.32 | $222.9K | 43.1K | 34 |
| 2020 | $56.24 | $12.02 | 4.68x | $44.22 | $2.3M | 187.3K | 55 |
| 2021 | $62.97 | $14.27 | 4.41x | $48.70 | $1.9M | 131.3K | 49 |
| 2022 | $68.78 | $15.35 | 4.48x | $53.43 | $2.4M | 157.6K | 52 |
| 2023 | $81.95 | $17.67 | 4.64x | $64.28 | $3.0M | 170.1K | 55 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J9271 | Injection, pembrolizumab, 1 mg | 84.9K | $3.5M | $41.76 | 3.35x |
| J9299 | Injection, nivolumab, 1 mg | 74.8K | $1.7M | $22.54 | 3.40x |
| J9144 | Injection, daratumumab, 10 mg and hyaluronidase-fihj | 25.6K | $910.8K | $35.62 | 3.73x |
| J0897 | Injection, denosumab, 1 mg | 25.9K | $425.1K | $16.40 | 3.74x |
| J1568 | Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg | 8.0K | $262.8K | $32.93 | 7.35x |
| J0881 | Injection, darbepoetin alfa, 1 microgram (non-esrd use) | 97.6K | $260.0K | $2.66 | 7.88x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 2.6K | $241.8K | $91.42 | 3.08x |
| J2505 | Injection, pegfilgrastim, 6 mg | 80 | $231.7K | $2.9K | 5.81x |
| J9041 | Injection, bortezomib (velcade), 0.1 mg | 6.2K | $223.7K | $35.91 | 3.45x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 2.0K | $219.8K | $107.72 | 6.87x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 2.6K | $160.8K | $62.86 | 2.87x |
| Q5119 | Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg | 3.7K | $135.8K | $37.09 | 5.23x |
| G9678 | Oncology care model (ocm) monthly enhanced oncology services (meos) payment for ocm enhanced services. g9678 payments may only be made to ocm practitioners for ocm beneficiaries for the furnishment of enhanced services as defined in the ocm participation a | 719 | $114.6K | $159.36 | 1.00x |
| 99215 | Established patient office or other outpatient visit, 40-54 minutes | 750 | $96.9K | $129.20 | 2.93x |
| 88185 | Flow cytometry technique for dna or cell analysis, each additional marker | 4.6K | $77.3K | $17.00 | 10.30x |
| 80053 | Blood test, comprehensive group of blood chemicals | 5.8K | $60.7K | $10.44 | 5.94x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | 7.6K | $58.3K | $7.69 | 4.55x |
| J9217 | Leuprolide acetate (for depot suspension), 7.5 mg | 395 | $58.0K | $146.80 | 26.83x |
| Q0138 | Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (non-esrd use) | 79.0K | $54.3K | $0.69 | 8.39x |
| J9025 | Injection, azacitidine, 1 mg | 91.8K | $52.1K | $0.57 | 34.48x |
This provider submits charges 4.59 times higher than what Medicare actually pays.
A markup ratio of 4.59x means for every $100 Medicare pays, this provider initially charges $459. 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.
Other Hematology-Oncology providers in VA for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Thomas Alberico, MD | Norfolk, VA | $38.5M | ⚠️ Flagged |
| Mark Fleming, MD | Hampton, VA | $37.6M | ⚠️ Flagged |
Share this provider's Medicare payment information
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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