Statistical flag only — not an accusation of fraud
⚠️ This provider averages 231 services per working day — physically unusual for an individual practitioner
Based on 577.4K total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $11.8M in total Medicare payments ranks in the 99th percentile of Hematology-Oncology providers nationally.
Averaging 231 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 2539% from 2014 to 2023.
This provider has been statistically flagged with a risk score of 72/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 292% in 2018
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 | $160.12 | $65.73 | 2.44x | $94.39 | $125.9K | 1.9K | 10 |
| 2015 | $158.00 | $63.59 | 2.48x | $94.41 | $126.4K | 2.0K | 10 |
| 2016 | $185.96 | $62.95 | 2.95x | $123.01 | $123.9K | 2.0K | 10 |
| 2017 | $213.71 | $67.08 | 3.19x | $146.63 | $125.9K | 1.9K | 9 |
| 2018 | $90.52 | $35.87 | 2.52x | $54.65 | $493.7K | 13.8K | 17 |
| 2019 | $84.77 | $34.64 | 2.45x | $50.13 | $611.4K | 17.6K | 16 |
| 2020 | $84.23 | $30.16 | 2.79x | $54.07 | $1.5M | 49.1K | 31 |
| 2021 | $76.92 | $16.28 | 4.72x | $60.64 | $2.2M | 137.6K | 45 |
| 2022 | $74.56 | $17.70 | 4.21x | $56.86 | $3.2M | 179.0K | 46 |
| 2023 | $78.61 | $19.25 | 4.08x | $59.36 | $3.3M | 172.5K | 42 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J9271 | Injection, pembrolizumab, 1 mg | 120.2K | $5.0M | $41.89 | 3.01x |
| J9299 | Injection, nivolumab, 1 mg | 92.1K | $2.1M | $22.40 | 3.00x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 10.3K | $773.6K | $74.74 | 2.75x |
| J2357 | Injection, omalizumab, 5 mg | 25.7K | $739.6K | $28.80 | 2.27x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 2.6K | $303.7K | $116.71 | 5.64x |
| J1561 | Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg | 9.4K | $293.7K | $31.31 | 2.41x |
| Q5107 | Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg | 6.0K | $240.9K | $40.48 | 4.58x |
| 99215 | Established patient office or other outpatient visit, 40-54 minutes | 2.0K | $212.6K | $106.71 | 2.60x |
| J9145 | Injection, daratumumab, 10 mg | 4.3K | $191.8K | $44.40 | 2.47x |
| J0897 | Injection, denosumab, 1 mg | 10.0K | $179.7K | $17.93 | 2.84x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 3.5K | $176.4K | $50.60 | 2.77x |
| J9217 | Leuprolide acetate (for depot suspension), 7.5 mg | 885 | $128.6K | $145.28 | 23.84x |
| J1437 | Injection, ferric derisomaltose, 10 mg | 6.9K | $117.4K | $17.01 | 4.35x |
| J0881 | Injection, darbepoetin alfa, 1 microgram (non-esrd use) | 45.5K | $112.2K | $2.46 | 8.52x |
| 99205 | New patient office or other outpatient visit, 60-74 minutes | 704 | $107.5K | $152.71 | 2.61x |
| Q5119 | Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg | 1.8K | $93.1K | $51.72 | 3.75x |
| 96401 | Administration of non-hormonal anti-neoplastic chemotherapy under skin or into muscle | 1.3K | $90.1K | $67.12 | 2.47x |
| J0185 | Injection, aprepitant, 1 mg | 61.0K | $82.4K | $1.35 | 6.66x |
| J2182 | Injection, mepolizumab, 1 mg | 3.5K | $68.9K | $19.68 | 2.61x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 1.1K | $65.4K | $59.44 | 2.18x |
This provider submits charges 3.87 times higher than what Medicare actually pays.
A markup ratio of 3.87x means for every $100 Medicare pays, this provider initially charges $387. 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 Hematology-Oncology providers in MD for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| David Smith, MD | Easton, MD | $48.3M | ✓ Clear |
| Frederick Smith, M.D. | Chevy Chase, MD | $33.7M | ✓ 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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