Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 89.6% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #195 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 $627.9K in total Medicare payments ranks in the 96th percentile of Emergency Medicine providers nationally.
Medicare payments to this provider grew 118% 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 | $136.0K | $60.92 | 2.10x |
| 99214 | Office visit, established patient, moderate complexity | 2.0K | $122.4K | $60.91 | 1.87x |
| 99215 | Office visit, established patient, high complexity | 1.8K | $108.8K | $60.90 | 2.28x |
| 99232 | Subsequent hospital care, moderate complexity | 1.6K | $95.2K | $60.89 | 1.78x |
| 99233 | Subsequent hospital care, high complexity | 1.3K | $81.6K | $60.93 | 2.15x |
| 93000 | Electrocardiogram, complete | 1.1K | $68.0K | $60.92 | 2.06x |
| 71046 | Chest X-ray, 2 views | 893 | $54.4K | $60.90 | 1.80x |
| 80053 | Comprehensive metabolic panel | 670 | $40.8K | $60.88 | 2.49x |
| 85025 | Complete blood count with differential | 446 | $27.2K | $60.97 | 2.07x |
| 36415 | Venipuncture for blood draw | 223 | $13.6K | $60.97 | 2.05x |
This provider submits charges 2.09 times higher than what Medicare actually pays.
A markup ratio of 2.09x means for every $100 Medicare pays, this provider initially charges $209. 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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