Statistical flag only — not an accusation of fraud
This provider's $1.4M in total Medicare payments ranks in the 88th percentile of Hematology-Oncology providers nationally.
Their average markup ratio of 29.84x is significantly above the specialty median of 3.5x.
Medicare payments to this provider grew 77% from 2014 to 2023.
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 | $408.51 | $13.69 | 29.84x | $394.82 | $100.3K | 7.3K | 258 |
| 2015 | $408.51 | $13.69 | 29.84x | $394.82 | $109.0K | 8.0K | 280 |
| 2016 | $408.51 | $13.69 | 29.84x | $394.82 | $117.6K | 8.6K | 302 |
| 2017 | $408.51 | $13.69 | 29.84x | $394.82 | $126.2K | 9.2K | 325 |
| 2018 | $408.51 | $13.69 | 29.84x | $394.82 | $134.8K | 9.8K | 347 |
| 2019 | $408.51 | $13.69 | 29.84x | $394.82 | $143.4K | 10.5K | 369 |
| 2020 | $408.51 | $13.69 | 29.84x | $394.82 | $152.0K | 11.1K | 391 |
| 2021 | $408.51 | $13.69 | 29.84x | $394.82 | $160.6K | 11.7K | 413 |
| 2022 | $408.51 | $13.69 | 29.84x | $394.82 | $169.2K | 12.4K | 435 |
| 2023 | $408.51 | $13.69 | 29.84x | $394.82 | $177.8K | 13.0K | 457 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99213 | Office/outpatient visit, est patient, low | 35.7K | $489.4K | $13.69 | 27.07x |
| 99214 | Office/outpatient visit, est patient, moderate | 17.9K | $244.7K | $13.69 | 24.54x |
| 99215 | Office/outpatient visit, est patient, high | 11.9K | $163.1K | $13.69 | 24.98x |
| 99223 | Initial hospital care, high complexity | 8.9K | $122.4K | $13.69 | 27.95x |
| 99232 | Subsequent hospital care, moderate | 7.1K | $97.9K | $13.69 | 24.16x |
| 93000 | Electrocardiogram, complete | 6.0K | $81.6K | $13.69 | 28.28x |
| 71046 | Chest X-ray, 2 views | 5.1K | $69.9K | $13.69 | 26.33x |
| 80053 | Comprehensive metabolic panel | 4.5K | $61.2K | $13.69 | 27.58x |
| 85025 | Complete blood count (CBC) | 4.0K | $54.4K | $13.70 | 32.20x |
| 36415 | Venipuncture | 3.6K | $48.9K | $13.69 | 25.34x |
This provider submits charges 29.84 times higher than what Medicare actually pays.
A markup ratio of 29.84x means for every $100 Medicare pays, this provider initially charges $2984. 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 Hematology-Oncology providers in VA for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Thomas Alberico, MD | Norfolk, VA | $38.5M | ⚠️ Flagged |
| Mark Fleming, MD | Hampton, VA | $37.6M | ⚠️ Flagged |
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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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