Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 88.2% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #310 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 $214.9K in total Medicare payments ranks in the 74th percentile of Physical Medicine and Rehabilitation providers nationally.
Medicare payments to this provider grew 97% 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 | 1.2K | $45.9K | $37.57 | 1.74x |
| 99214 | Office visit, established patient, moderate complexity | 1.1K | $41.3K | $37.56 | 2.24x |
| 99215 | Office visit, established patient, high complexity | 978 | $36.7K | $37.55 | 2.15x |
| 99232 | Subsequent hospital care, moderate complexity | 856 | $32.1K | $37.54 | 1.94x |
| 99233 | Subsequent hospital care, high complexity | 733 | $27.5K | $37.58 | 1.66x |
| 93000 | Electrocardiogram, complete | 611 | $23.0K | $37.57 | 2.18x |
| 71046 | Chest X-ray, 2 views | 489 | $18.4K | $37.55 | 1.90x |
| 80053 | Comprehensive metabolic panel | 367 | $13.8K | $37.53 | 1.88x |
| 85025 | Complete blood count with differential | 244 | $9.2K | $37.63 | 1.92x |
| 36415 | Venipuncture for blood draw | 122 | $4.6K | $37.63 | 2.02x |
This provider submits charges 2 times higher than what Medicare actually pays.
A markup ratio of 2x means for every $100 Medicare pays, this provider initially charges $200. This is lower 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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