Statistical flag only — not an accusation of fraud
⚠️ This provider averages 407 services per working day — physically unusual for an individual practitioner
Based on 1.0M total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $11.4M in total Medicare payments ranks in the 99th percentile of Obstetrics & Gynecology providers nationally.
Averaging 407 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 2395% from 2014 to 2023.
This provider has been statistically flagged with a risk score of 69/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 214% in 2019
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 |
|---|---|---|---|---|---|---|---|
| 2014 | $67.63 | $25.45 | 2.66x | $42.18 | $118.5K | 4.7K | 11 |
| 2015 | $63.14 | $31.46 | 2.01x | $31.68 | $107.4K | 3.4K | 11 |
| 2016 | $59.95 | $20.52 | 2.92x | $39.43 | $189.1K | 9.2K | 11 |
| 2017 | $42.55 | $20.16 | 2.11x | $22.39 | $244.1K | 12.1K | 8 |
| 2018 | $41.58 | $19.25 | 2.16x | $22.33 | $325.8K | 16.9K | 11 |
| 2019 | $40.16 | $14.95 | 2.69x | $25.21 | $1.0M | 68.4K | 12 |
| 2020 | $29.56 | $9.93 | 2.98x | $19.63 | $1.9M | 190.6K | 13 |
| 2021 | $28.44 | $10.76 | 2.64x | $17.68 | $2.0M | 187.4K | 14 |
| 2022 | $25.05 | $10.27 | 2.44x | $14.78 | $2.5M | 244.8K | 11 |
| 2023 | $24.81 | $10.59 | 2.34x | $14.22 | $3.0M | 279.3K | 10 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J3111 | Injection, romosozumab-aqqg, 1 mg | 673.2K | $5.1M | $7.51 | 2.85x |
| J0897 | Injection, denosumab, 1 mg | 312.8K | $5.0M | $16.02 | 1.88x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 4.3K | $376.6K | $86.58 | 2.38x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 1.5K | $192.0K | $128.26 | 2.10x |
| 99215 | Established patient office or other outpatient visit, 40-54 minutes | 1.4K | $162.8K | $115.41 | 2.34x |
| J3490 | Unclassified drugs | 77 | $113.7K | $1.5K | 3.03x |
| 99221 | Initial hospital care with straightforward or low level of medical decision making, per day, if using time, at least 40 minutes | 1.3K | $110.7K | $83.49 | 2.14x |
| 96372 | Injection of drug or substance under skin or into muscle | 8.6K | $110.6K | $12.85 | 4.28x |
| 96365 | Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less | 1.9K | $99.1K | $51.23 | 3.90x |
| J3489 | Injection, zoledronic acid, 1 mg | 9.6K | $72.5K | $7.56 | 26.66x |
| G0101 | Cervical or vaginal cancer screening; pelvic and clinical breast examination | 926 | $37.9K | $40.96 | 2.06x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 604 | $35.2K | $58.26 | 2.44x |
| 99205 | New patient office or other outpatient visit, 60-74 minutes | 17 | $3.2K | $186.07 | 2.39x |
| Q0091 | Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory | 60 | $2.9K | $47.65 | 1.78x |
| 99442 | Physician telephone patient service, 11-20 minutes of medical discussion | 36 | $2.2K | $60.92 | 2.54x |
| 99443 | Physician telephone patient service, 21-30 minutes of medical discussion | 13 | $1.2K | $95.28 | 2.47x |
| 99231 | Subsequent hospital inpatient care, typically 15 minutes per day | 38 | $1.2K | $32.35 | 2.50x |
| 36415 | Insertion of needle into vein for collection of blood sample | 298 | $878.46 | $2.95 | 6.78x |
| 99212 | Established patient office or other outpatient visit, typically 10 minutes | 16 | $558.30 | $34.89 | 1.99x |
This provider submits charges 2.55 times higher than what Medicare actually pays.
A markup ratio of 2.55x means for every $100 Medicare pays, this provider initially charges $255. 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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