Statistical flag only — not an accusation of fraud
⚠️ This provider averages 1.0K services per working day — physically unusual for an individual practitioner
Based on 2.5M total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $23.9M in total Medicare payments ranks in the 99th percentile of Hematology providers nationally.
Averaging 1.0K services per working day raises questions about billing patterns.
Medicare payments to this provider grew 167% from 2014 to 2023.
This provider has been statistically flagged with a risk score of 74/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 96% in 2016
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 |
|---|---|---|---|---|---|---|---|
| 2014 | $38.27 | $8.71 | 4.39x | $29.56 | $1.2M | 136.3K | 30 |
| 2015 | $21.25 | $4.31 | 4.93x | $16.94 | $793.1K | 184.0K | 32 |
| 2016 | $34.62 | $7.94 | 4.36x | $26.68 | $1.6M | 196.1K | 34 |
| 2017 | $44.42 | $9.44 | 4.71x | $34.98 | $2.0M | 211.0K | 36 |
| 2018 | $46.51 | $10.31 | 4.51x | $36.20 | $2.2M | 211.2K | 38 |
| 2019 | $49.86 | $11.54 | 4.32x | $38.32 | $3.6M | 312.2K | 53 |
| 2020 | $37.90 | $8.05 | 4.71x | $29.85 | $2.3M | 290.6K | 48 |
| 2021 | $39.04 | $8.74 | 4.47x | $30.30 | $2.9M | 326.0K | 51 |
| 2022 | $52.76 | $11.54 | 4.57x | $41.22 | $4.2M | 364.2K | 52 |
| 2023 | $53.23 | $11.09 | 4.80x | $42.14 | $3.2M | 286.4K | 52 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J9035 | Injection, bevacizumab, 10 mg | 67.1K | $4.0M | $59.34 | 3.41x |
| J9271 | Injection, pembrolizumab, 1 mg | 84.4K | $3.5M | $41.36 | 3.05x |
| J2505 | Injection, pegfilgrastim, 6 mg | 758 | $2.4M | $3.2K | 4.88x |
| J0881 | Injection, darbepoetin alfa, 1 microgram (non-esrd use) | 691.4K | $2.0M | $2.86 | 7.07x |
| J0897 | Injection, denosumab, 1 mg | 97.6K | $1.6M | $16.06 | 3.11x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 15.2K | $1.5M | $96.75 | 2.38x |
| J9299 | Injection, nivolumab, 1 mg | 45.8K | $1.1M | $23.17 | 3.06x |
| J9144 | Injection, daratumumab, 10 mg and hyaluronidase-fihj | 24.7K | $906.5K | $36.75 | 3.52x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 6.6K | $866.2K | $130.50 | 5.26x |
| J1568 | Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg | 21.5K | $669.3K | $31.19 | 6.16x |
| Q5107 | Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg | 17.9K | $623.6K | $34.88 | 5.33x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 6.3K | $440.2K | $69.51 | 2.17x |
| Q5118 | Injection, bevacizumab-bvzr, biosimilar, (zirabev), 10 mg | 12.7K | $331.8K | $26.03 | 6.38x |
| J2469 | Injection, palonosetron hcl, 25 mcg | 25.8K | $269.6K | $10.45 | 11.47x |
| 96365 | Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less | 3.7K | $240.4K | $64.86 | 4.69x |
| J9310 | Injection, rituximab, 100 mg | 372 | $204.9K | $550.78 | 3.35x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | 23.0K | $204.3K | $8.87 | 3.95x |
| J1453 | Injection, fosaprepitant, 1 mg | 148.7K | $190.6K | $1.28 | 4.50x |
| 96367 | Infusion into a vein for therapy, prevention, or diagnosis, additional sequential infusion, 1 hour or less | 6.1K | $173.8K | $28.57 | 5.32x |
| J9041 | Injection, bortezomib, 0.1 mg | 7.2K | $165.9K | $23.16 | 5.35x |
This provider submits charges 4.56 times higher than what Medicare actually pays.
A markup ratio of 4.56x means for every $100 Medicare pays, this provider initially charges $456. 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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