Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 91.7% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #133 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 $716.5K in total Medicare payments ranks in the 94th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 108% 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 | 2.3K | $153.6K | $65.59 | 1.68x |
| 99214 | Office visit, established patient, moderate complexity | 2.1K | $138.2K | $65.59 | 1.73x |
| 99215 | Office visit, established patient, high complexity | 1.9K | $122.8K | $65.59 | 1.66x |
| 99232 | Subsequent hospital care, moderate complexity | 1.6K | $107.5K | $65.58 | 2.10x |
| 99233 | Subsequent hospital care, high complexity | 1.4K | $92.1K | $65.58 | 1.98x |
| 93000 | Electrocardiogram, complete | 1.2K | $76.8K | $65.62 | 2.26x |
| 71046 | Chest X-ray, 2 views | 936 | $61.4K | $65.62 | 2.16x |
| 80053 | Comprehensive metabolic panel | 702 | $46.1K | $65.62 | 1.96x |
| 85025 | Complete blood count with differential | 468 | $30.7K | $65.62 | 2.07x |
| 36415 | Venipuncture for blood draw | 234 | $15.4K | $65.62 | 1.69x |
This provider submits charges 1.92 times higher than what Medicare actually pays.
A markup ratio of 1.92x means for every $100 Medicare pays, this provider initially charges $192. This is lower 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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