Statistical flag only — not an accusation of fraud
⚠️ This provider averages 644 services per working day — physically unusual for an individual practitioner
Based on 643.8K total services over 4 years (250 working days/year). Learn about impossible service volumes →
This provider's $7.7M in total Medicare payments ranks in the 99th percentile of General Practice providers nationally.
Averaging 644 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 26858% from 2020 to 2023.
97% of their billing comes from a single procedure code (K1034 — Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count).
This provider has been statistically flagged with a risk score of 70/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 6426% in 2023
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 |
|---|---|---|---|---|---|---|---|
| 2020 | $738.52 | $97.56 | 7.57x | $640.96 | $28.2K | 289 | 5 |
| 2021 | $831.00 | $101.85 | 8.16x | $729.15 | $4.8K | 47 | 2 |
| 2022 | $792.22 | $98.03 | 8.08x | $694.19 | $116.5K | 1.2K | 10 |
| 2023 | $24.29 | $11.83 | 2.05x | $12.46 | $7.6M | 642.3K | 7 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| K1034 | Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count | 641.5K | $7.5M | $11.76 | 2.04x |
| 99310 | Follow-up nursing facility visit per day, typically 35 minutes | 587 | $58.5K | $99.65 | 7.33x |
| 99285 | Emergency department visit with high level of medical decision making | 341 | $44.8K | $131.35 | 7.69x |
| 99284 | Emergency department visit with moderate level of medical decision making | 443 | $38.8K | $87.58 | 6.13x |
| 99233 | Follow-up hospital inpatient care per day, typically 35 minutes | 238 | $18.7K | $78.41 | 5.94x |
| 99223 | Initial hospital inpatient care per day, typically 70 minutes | 102 | $15.3K | $150.45 | 6.20x |
| 99283 | Emergency department visit with low level of medical decision making | 148 | $7.6K | $51.50 | 6.85x |
| 99239 | Hospital discharge day management, more than 30 minutes | 65 | $5.2K | $80.44 | 6.39x |
| 99306 | Initial nursing facility visit per day, typically 45 minutes | 35 | $4.3K | $123.55 | 7.33x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 37 | $3.5K | $94.70 | 3.22x |
| 99291 | Critical care, first 30-74 minutes | 18 | $2.9K | $159.19 | 7.31x |
| 99316 | Nursing facility discharge management, more than 30 minutes | 36 | $2.8K | $77.57 | 7.35x |
| 99282 | Emergency department visit with straightforward medical decision making | 48 | $1.3K | $27.14 | 3.03x |
| 93000 | Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report | 80 | $804.73 | $10.06 | 2.18x |
| 93010 | Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only | 124 | $687.52 | $5.54 | 4.93x |
This provider submits charges 2.17 times higher than what Medicare actually pays.
A markup ratio of 2.17x means for every $100 Medicare pays, this provider initially charges $217. 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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