Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 86.4% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #484 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 $215.3K in total Medicare payments ranks in the 81th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 119% 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 | 828 | $47.4K | $57.21 | 2.51x |
| 99214 | Office visit, established patient, moderate complexity | 745 | $42.6K | $57.23 | 2.69x |
| 99215 | Office visit, established patient, high complexity | 662 | $37.9K | $57.25 | 2.34x |
| 99232 | Subsequent hospital care, moderate complexity | 580 | $33.2K | $57.18 | 2.10x |
| 99233 | Subsequent hospital care, high complexity | 497 | $28.4K | $57.19 | 1.98x |
| 93000 | Electrocardiogram, complete | 414 | $23.7K | $57.21 | 1.95x |
| 71046 | Chest X-ray, 2 views | 331 | $18.9K | $57.25 | 2.05x |
| 80053 | Comprehensive metabolic panel | 248 | $14.2K | $57.31 | 2.00x |
| 85025 | Complete blood count with differential | 166 | $9.5K | $57.08 | 2.69x |
| 36415 | Venipuncture for blood draw | 83 | $4.7K | $57.07 | 2.15x |
This provider submits charges 2.38 times higher than what Medicare actually pays.
A markup ratio of 2.38x means for every $100 Medicare pays, this provider initially charges $238. 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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