Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 89.6% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #173 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 $1.2M in total Medicare payments ranks in the 96th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 120% 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 | 7.6K | $254.9K | $33.35 | 3.60x |
| 99214 | Office visit, established patient, moderate complexity | 6.9K | $229.4K | $33.35 | 2.64x |
| 99215 | Office visit, established patient, high complexity | 6.1K | $203.9K | $33.35 | 3.74x |
| 99232 | Subsequent hospital care, moderate complexity | 5.3K | $178.4K | $33.35 | 3.57x |
| 99233 | Subsequent hospital care, high complexity | 4.6K | $152.9K | $33.35 | 3.36x |
| 93000 | Electrocardiogram, complete | 3.8K | $127.4K | $33.35 | 3.58x |
| 71046 | Chest X-ray, 2 views | 3.1K | $101.9K | $33.35 | 3.66x |
| 80053 | Comprehensive metabolic panel | 2.3K | $76.5K | $33.36 | 3.05x |
| 85025 | Complete blood count with differential | 1.5K | $51.0K | $33.36 | 3.53x |
| 36415 | Venipuncture for blood draw | 764 | $25.5K | $33.36 | 2.98x |
This provider submits charges 3.23 times higher than what Medicare actually pays.
A markup ratio of 3.23x means for every $100 Medicare pays, this provider initially charges $323. 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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