Statistical flag only — not an accusation of fraud
This provider's $1.6M in total Medicare payments ranks in the 89th percentile of Hematology-Oncology providers nationally.
Their average markup ratio of 26.74x is significantly above the specialty median of 3.5x.
Medicare payments to this provider grew 77% from 2014 to 2023.
This provider has been statistically flagged with a risk score of 67/100. 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 | $352.97 | $13.20 | 26.74x | $339.77 | $108.8K | 8.2K | 298 |
| 2015 | $352.97 | $13.20 | 26.74x | $339.77 | $118.1K | 8.9K | 323 |
| 2016 | $352.97 | $13.20 | 26.74x | $339.77 | $127.4K | 9.7K | 349 |
| 2017 | $352.97 | $13.20 | 26.74x | $339.77 | $136.8K | 10.4K | 374 |
| 2018 | $352.97 | $13.20 | 26.74x | $339.77 | $146.1K | 11.1K | 400 |
| 2019 | $352.97 | $13.20 | 26.74x | $339.77 | $155.4K | 11.8K | 426 |
| 2020 | $352.97 | $13.20 | 26.74x | $339.77 | $164.7K | 12.5K | 451 |
| 2021 | $352.97 | $13.20 | 26.74x | $339.77 | $174.1K | 13.2K | 477 |
| 2022 | $352.97 | $13.20 | 26.74x | $339.77 | $183.4K | 13.9K | 502 |
| 2023 | $352.97 | $13.20 | 26.74x | $339.77 | $192.7K | 14.6K | 528 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99213 | Office/outpatient visit, est patient, low | 40.2K | $530.6K | $13.20 | 30.78x |
| 99214 | Office/outpatient visit, est patient, moderate | 20.1K | $265.3K | $13.20 | 25.06x |
| 99215 | Office/outpatient visit, est patient, high | 13.4K | $176.9K | $13.20 | 23.21x |
| 99223 | Initial hospital care, high complexity | 10.0K | $132.6K | $13.20 | 31.73x |
| 99232 | Subsequent hospital care, moderate | 8.0K | $106.1K | $13.20 | 27.37x |
| 93000 | Electrocardiogram, complete | 6.7K | $88.4K | $13.20 | 30.71x |
| 71046 | Chest X-ray, 2 views | 5.7K | $75.8K | $13.20 | 31.00x |
| 80053 | Comprehensive metabolic panel | 5.0K | $66.3K | $13.20 | 22.98x |
| 85025 | Complete blood count (CBC) | 4.5K | $59.0K | $13.20 | 30.00x |
| 36415 | Venipuncture | 4.0K | $53.1K | $13.20 | 26.50x |
This provider submits charges 26.74 times higher than what Medicare actually pays.
A markup ratio of 26.74x means for every $100 Medicare pays, this provider initially charges $2674. 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 |
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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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