Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 91.8% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #170 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 $790.7K in total Medicare payments ranks in the 93th percentile of Physical Medicine and Rehabilitation providers nationally.
Medicare payments to this provider grew 125% 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 | 2.2K | $171.8K | $78.08 | 2.49x |
| 99214 | Office visit, established patient, moderate complexity | 2.0K | $154.7K | $78.07 | 2.07x |
| 99215 | Office visit, established patient, high complexity | 1.8K | $137.5K | $78.07 | 2.93x |
| 99232 | Subsequent hospital care, moderate complexity | 1.5K | $120.3K | $78.06 | 2.39x |
| 99233 | Subsequent hospital care, high complexity | 1.3K | $103.1K | $78.05 | 3.02x |
| 93000 | Electrocardiogram, complete | 1.1K | $85.9K | $78.11 | 2.87x |
| 71046 | Chest X-ray, 2 views | 880 | $68.7K | $78.11 | 3.07x |
| 80053 | Comprehensive metabolic panel | 660 | $51.6K | $78.11 | 2.77x |
| 85025 | Complete blood count with differential | 440 | $34.4K | $78.11 | 2.66x |
| 36415 | Venipuncture for blood draw | 220 | $17.2K | $78.11 | 2.98x |
This provider submits charges 2.56 times higher than what Medicare actually pays.
A markup ratio of 2.56x means for every $100 Medicare pays, this provider initially charges $256. 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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