Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 92.9% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #55 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 $565.0K in total Medicare payments ranks in the 93th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 109% 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 | 2.0K | $122.5K | $62.70 | 2.47x |
| 99214 | Office visit, established patient, moderate complexity | 1.8K | $110.2K | $62.69 | 2.67x |
| 99215 | Office visit, established patient, high complexity | 1.6K | $98.0K | $62.72 | 1.87x |
| 99232 | Subsequent hospital care, moderate complexity | 1.4K | $85.7K | $62.71 | 2.44x |
| 99233 | Subsequent hospital care, high complexity | 1.2K | $73.5K | $62.69 | 2.56x |
| 93000 | Electrocardiogram, complete | 977 | $61.2K | $62.67 | 2.59x |
| 71046 | Chest X-ray, 2 views | 781 | $49.0K | $62.72 | 2.58x |
| 80053 | Comprehensive metabolic panel | 586 | $36.7K | $62.69 | 2.43x |
| 85025 | Complete blood count with differential | 391 | $24.5K | $62.64 | 1.84x |
| 36415 | Venipuncture for blood draw | 195 | $12.2K | $62.80 | 2.41x |
This provider submits charges 2.29 times higher than what Medicare actually pays.
A markup ratio of 2.29x means for every $100 Medicare pays, this provider initially charges $229. 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.
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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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