Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 92.3% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #86 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 $642.9K in total Medicare payments ranks in the 91th percentile of Physical Medicine and Rehabilitation providers nationally.
Medicare payments to this provider grew 94% 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 | 2.6K | $137.7K | $52.70 | 2.99x |
| 99214 | Office visit, established patient, moderate complexity | 2.4K | $123.9K | $52.70 | 2.39x |
| 99215 | Office visit, established patient, high complexity | 2.1K | $110.2K | $52.71 | 2.56x |
| 99232 | Subsequent hospital care, moderate complexity | 1.8K | $96.4K | $52.71 | 2.29x |
| 99233 | Subsequent hospital care, high complexity | 1.6K | $82.6K | $52.70 | 3.11x |
| 93000 | Electrocardiogram, complete | 1.3K | $68.9K | $52.73 | 2.44x |
| 71046 | Chest X-ray, 2 views | 1.0K | $55.1K | $52.71 | 2.50x |
| 80053 | Comprehensive metabolic panel | 784 | $41.3K | $52.70 | 2.19x |
| 85025 | Complete blood count with differential | 523 | $27.5K | $52.67 | 3.01x |
| 36415 | Venipuncture for blood draw | 261 | $13.8K | $52.77 | 2.66x |
This provider submits charges 2.69 times higher than what Medicare actually pays.
A markup ratio of 2.69x means for every $100 Medicare pays, this provider initially charges $269. 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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