Statistical flag only — not an accusation of fraud
This provider's $333.5M in total Medicare payments ranks in the 99th percentile of Independent Diagnostic Testing Facility (IDTF) providers nationally.
97% of their billing comes from a single procedure code (G0249 — Provision of test materials and equipment for home inr monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria; includes: provision of materials for use in the).
This provider has been statistically flagged with a risk score of 68/100. 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 | $282.33 | $100.22 | 2.82x | $182.11 | $32.5M | 324.6K | 2 |
| 2015 | $285.06 | $112.04 | 2.54x | $173.02 | $38.1M | 339.8K | 2 |
| 2016 | $285.12 | $112.96 | 2.52x | $172.16 | $45.2M | 400.6K | 2 |
| 2017 | $284.91 | $109.87 | 2.59x | $175.04 | $47.5M | 432.3K | 2 |
| 2018 | $282.45 | $88.01 | 3.21x | $194.44 | $39.8M | 452.0K | 2 |
| 2019 | $283.45 | $70.99 | 3.99x | $212.46 | $31.7M | 446.5K | 2 |
| 2020 | $284.47 | $58.94 | 4.83x | $225.53 | $28.1M | 476.5K | 2 |
| 2021 | $283.11 | $58.56 | 4.83x | $224.55 | $26.5M | 453.2K | 2 |
| 2022 | $283.10 | $46.69 | 6.06x | $236.41 | $18.8M | 403.4K | 2 |
| 2023 | $283.53 | $68.16 | 4.16x | $215.37 | $25.2M | 369.7K | 2 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| G0249 | Provision of test materials and equipment for home inr monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria; includes: provision of materials for use in the | 4.0M | $323.4M | $81.18 | 3.46x |
| G0248 | Demonstration, prior to initiation of home inr monitoring, for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria, under the direction of a physician; includes: face-to | 115.2K | $10.1M | $87.79 | 4.45x |
This provider submits charges 3.49 times higher than what Medicare actually pays.
A markup ratio of 3.49x means for every $100 Medicare pays, this provider initially charges $349. 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 Independent Diagnostic Testing Facility (IDTF) providers in CA for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Cardionet, Llc. | Pleasanton, CA | $662.0M | ⚠️ Flagged |
| Irhythm Technologies, Inc. | San Francisco, CA | $393.0M | ⚠️ Flagged |
| Alere Home Monitoring, Inc. | Livermore, CA | $361.4M | ⚠️ Flagged |
| Medi-Lynx Cardiac Monitoring, Llc | San Francisco, CA | $88.5M | ✓ Clear |
| Modern Nuclear, Inc. | La Habra, CA | $50.0M | ✓ 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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