Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 92.1% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #82 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 $312.3K in total Medicare payments ranks in the 87th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 111% 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 | $69.0K | $58.49 | 2.21x |
| 99214 | Office visit, established patient, moderate complexity | 1.1K | $62.1K | $58.49 | 1.91x |
| 99215 | Office visit, established patient, high complexity | 944 | $55.2K | $58.49 | 1.76x |
| 99232 | Subsequent hospital care, moderate complexity | 826 | $48.3K | $58.49 | 1.74x |
| 99233 | Subsequent hospital care, high complexity | 708 | $41.4K | $58.49 | 1.55x |
| 93000 | Electrocardiogram, complete | 590 | $34.5K | $58.49 | 1.97x |
| 71046 | Chest X-ray, 2 views | 472 | $27.6K | $58.49 | 1.55x |
| 80053 | Comprehensive metabolic panel | 354 | $20.7K | $58.49 | 1.67x |
| 85025 | Complete blood count with differential | 236 | $13.8K | $58.49 | 1.85x |
| 36415 | Venipuncture for blood draw | 118 | $6.9K | $58.48 | 2.26x |
This provider submits charges 1.91 times higher than what Medicare actually pays.
A markup ratio of 1.91x means for every $100 Medicare pays, this provider initially charges $191. 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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