Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 94.7% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #23 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 $680.2K in total Medicare payments ranks in the 94th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 118% 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 | 2.4K | $147.8K | $62.14 | 2.31x |
| 99214 | Office visit, established patient, moderate complexity | 2.1K | $133.1K | $62.15 | 2.50x |
| 99215 | Office visit, established patient, high complexity | 1.9K | $118.3K | $62.15 | 2.40x |
| 99232 | Subsequent hospital care, moderate complexity | 1.7K | $103.5K | $62.15 | 2.01x |
| 99233 | Subsequent hospital care, high complexity | 1.4K | $88.7K | $62.16 | 2.38x |
| 93000 | Electrocardiogram, complete | 1.2K | $73.9K | $62.17 | 2.75x |
| 71046 | Chest X-ray, 2 views | 952 | $59.1K | $62.12 | 2.50x |
| 80053 | Comprehensive metabolic panel | 714 | $44.4K | $62.12 | 2.00x |
| 85025 | Complete blood count with differential | 476 | $29.6K | $62.12 | 2.77x |
| 36415 | Venipuncture for blood draw | 238 | $14.8K | $62.12 | 2.47x |
This provider submits charges 2.35 times higher than what Medicare actually pays.
A markup ratio of 2.35x means for every $100 Medicare pays, this provider initially charges $235. This is higher 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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