Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 87.5% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #350 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 $432.7K in total Medicare payments ranks in the 94th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 114% 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 | 2.7K | $93.9K | $35.02 | 1.84x |
| 99214 | Office visit, established patient, moderate complexity | 2.4K | $84.5K | $35.02 | 2.21x |
| 99215 | Office visit, established patient, high complexity | 2.1K | $75.1K | $35.02 | 1.98x |
| 99395 | Preventive visit, 18-39 years | 1.9K | $65.7K | $35.01 | 1.72x |
| 99396 | Preventive visit, 40-64 years | 1.6K | $56.3K | $35.01 | 1.71x |
| 93000 | Electrocardiogram, complete | 1.3K | $46.9K | $35.01 | 2.38x |
| 71046 | Chest X-ray, 2 views | 1.1K | $37.6K | $35.03 | 2.20x |
| 80053 | Comprehensive metabolic panel | 804 | $28.2K | $35.03 | 2.25x |
| 85025 | Complete blood count with differential | 536 | $18.8K | $35.03 | 1.70x |
| 36415 | Venipuncture for blood draw | 268 | $9.4K | $35.03 | 2.41x |
This provider submits charges 2.05 times higher than what Medicare actually pays.
A markup ratio of 2.05x means for every $100 Medicare pays, this provider initially charges $205. This is higher than the national average.
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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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