Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 89.9% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #225 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 $339.2K in total Medicare payments ranks in the 88th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 103% 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 | 1.6K | $73.0K | $45.23 | 2.14x |
| 99214 | Office visit, established patient, moderate complexity | 1.5K | $65.7K | $45.22 | 2.13x |
| 99215 | Office visit, established patient, high complexity | 1.3K | $58.4K | $45.24 | 2.42x |
| 99232 | Subsequent hospital care, moderate complexity | 1.1K | $51.1K | $45.22 | 2.06x |
| 99233 | Subsequent hospital care, high complexity | 968 | $43.8K | $45.25 | 2.72x |
| 93000 | Electrocardiogram, complete | 807 | $36.5K | $45.23 | 1.98x |
| 71046 | Chest X-ray, 2 views | 646 | $29.2K | $45.20 | 2.19x |
| 80053 | Comprehensive metabolic panel | 484 | $21.9K | $45.25 | 2.70x |
| 85025 | Complete blood count with differential | 323 | $14.6K | $45.20 | 2.61x |
| 36415 | Venipuncture for blood draw | 161 | $7.3K | $45.34 | 2.16x |
This provider submits charges 2.38 times higher than what Medicare actually pays.
A markup ratio of 2.38x means for every $100 Medicare pays, this provider initially charges $238. 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.
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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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