Statistical flag only — not an accusation of fraud
This provider averages 51 services per working day
Based on 126.4K total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $1.3M in total Medicare payments ranks in the 97th percentile of Internal Medicine providers nationally.
Their average markup ratio of 20.91x is significantly above the specialty median of 2.9x.
Averaging 51 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 77% 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.
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 | $218.09 | $10.43 | 20.91x | $207.66 | $92.3K | 8.9K | 350 |
| 2015 | $217.88 | $10.42 | 20.91x | $207.46 | $100.2K | 9.6K | 380 |
| 2016 | $218.09 | $10.43 | 20.91x | $207.66 | $108.1K | 10.4K | 410 |
| 2017 | $218.09 | $10.43 | 20.91x | $207.66 | $116.0K | 11.1K | 440 |
| 2018 | $217.88 | $10.42 | 20.91x | $207.46 | $123.9K | 11.9K | 470 |
| 2019 | $218.09 | $10.43 | 20.91x | $207.66 | $131.8K | 12.6K | 500 |
| 2020 | $218.09 | $10.43 | 20.91x | $207.66 | $139.7K | 13.4K | 530 |
| 2021 | $217.88 | $10.42 | 20.91x | $207.46 | $147.6K | 14.2K | 560 |
| 2022 | $218.09 | $10.43 | 20.91x | $207.66 | $155.5K | 14.9K | 590 |
| 2023 | $218.09 | $10.43 | 20.91x | $207.66 | $163.5K | 15.7K | 620 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99213 | Office visit, est patient, low complexity | 43.2K | $450.1K | $10.43 | 23.31x |
| 99214 | Office visit, est patient, moderate complexity | 21.6K | $225.0K | $10.43 | 24.54x |
| 99215 | Office visit, est patient, high complexity | 14.4K | $150.0K | $10.43 | 17.09x |
| 99232 | Subsequent hospital care, moderate complexity | 10.8K | $112.5K | $10.43 | 24.16x |
| 99233 | Subsequent hospital care, high complexity | 8.6K | $90.0K | $10.43 | 18.25x |
| 93000 | Electrocardiogram, complete | 7.2K | $75.0K | $10.43 | 18.64x |
| 71046 | Chest X-ray, 2 views | 6.2K | $64.3K | $10.43 | 18.70x |
| 80053 | Comprehensive metabolic panel | 5.4K | $56.3K | $10.43 | 19.52x |
| 85025 | Complete blood count (CBC) | 4.8K | $50.0K | $10.42 | 21.74x |
| 36415 | Venipuncture | 4.3K | $45.0K | $10.43 | 23.29x |
This provider submits charges 20.91 times higher than what Medicare actually pays.
A markup ratio of 20.91x means for every $100 Medicare pays, this provider initially charges $2091. 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 Internal Medicine providers in TX for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Owen Ellington, M.D, J.D. | Humble, TX | $34.4M | ✓ Clear |
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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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