Statistical flag only — not an accusation of fraud
This provider averages 92 services per working day
Based on 115.5K total services over 5 years (250 working days/year). Learn about impossible service volumes →
This provider's $20.5M in total Medicare payments ranks in the 99th percentile of General Surgery providers nationally.
Averaging 92 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 11316% from 2019 to 2023.
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 578% 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 |
|---|---|---|---|---|---|---|---|
| 2019 | $223.87 | $70.63 | 3.17x | $153.24 | $142.9K | 2.0K | 7 |
| 2020 | $119.28 | $61.69 | 1.93x | $57.59 | $390.1K | 6.3K | 11 |
| 2021 | $112.52 | $62.24 | 1.81x | $50.28 | $1.2M | 19.9K | 16 |
| 2022 | $154.79 | $73.38 | 2.11x | $81.41 | $2.4M | 32.8K | 20 |
| 2023 | $470.67 | $299.35 | 1.57x | $171.32 | $16.3M | 54.5K | 25 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| Q4236 | Carepatch, per square centimeter | 10.0K | $10.0M | $997.46 | 1.43x |
| Q4205 | Membrane graft or membrane wrap, per square centimeter | 2.7K | $3.2M | $1.2K | 1.28x |
| 99308 | Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes | 26.7K | $1.7M | $63.89 | 1.79x |
| 99309 | Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes | 14.3K | $1.3M | $89.90 | 1.55x |
| 11042 | Removal of skin and tissue, 20.0 sq cm or less | 19.8K | $1.2M | $60.63 | 2.29x |
| 11043 | Removal of muscle and/or tissue, 20.0 sq cm or less | 6.2K | $1.1M | $180.56 | 3.23x |
| 11046 | Removal of muscle and/or tissue, each additional 20.0 sq cm or less | 9.5K | $596.3K | $62.75 | 2.34x |
| 99307 | Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 10 minutes | 12.1K | $452.9K | $37.53 | 2.37x |
| 99304 | Initial nursing facility care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes | 3.0K | $229.1K | $76.78 | 2.28x |
| 99305 | Initial nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes | 1.9K | $216.9K | $116.85 | 1.34x |
| 11045 | Removal of skin and tissue, each additional 20.0 sq cm or less | 6.8K | $195.2K | $28.75 | 2.50x |
| 99310 | Subsequent nursing facility care with high level of medical decision making, per day, if using time, at least 45 minutes | 768 | $96.9K | $126.18 | 1.46x |
| 15271 | Application of skin substitute graft to wound of trunk, arms, or legs, 25.0 sq cm or less of wound 100.0 sq cm or less | 444 | $62.1K | $139.82 | 1.70x |
| 99306 | Initial nursing facility care with high level of medical decision making, per day, if using time, at least 45 minutes | 308 | $47.5K | $154.18 | 1.92x |
| 99348 | Residence visit for established patient with low level of medical decision making, per day, if using time, at least 30 minutes | 411 | $28.1K | $68.39 | 2.93x |
| 99349 | Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes | 221 | $25.5K | $115.21 | 2.17x |
| 97597 | Removal of tissue from wounds per session, first 20 sq cms or less | 107 | $10.6K | $98.66 | 2.39x |
| 15272 | Application of skin substitute graft to wound of trunk, arms, or legs, each additional 25.0 sq cm of wound 100.0 sq cm or less | 222 | $5.1K | $22.97 | 10.43x |
| 99344 | Residence visit for new patient with moderate level of medical decision making, per day, if using time, at least 60 minutes | 16 | $2.1K | $130.19 | 1.92x |
This provider submits charges 1.67 times higher than what Medicare actually pays.
A markup ratio of 1.67x means for every $100 Medicare pays, this provider initially charges $167. 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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