Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 89.5% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #309 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 $176.6K in total Medicare payments ranks in the 76th 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 | 625 | $38.8K | $62.07 | 1.85x |
| 99214 | Office visit, established patient, moderate complexity | 563 | $34.9K | $62.02 | 2.05x |
| 99215 | Office visit, established patient, high complexity | 500 | $31.0K | $62.07 | 2.35x |
| 99232 | Subsequent hospital care, moderate complexity | 438 | $27.2K | $62.00 | 2.31x |
| 99233 | Subsequent hospital care, high complexity | 375 | $23.3K | $62.07 | 2.49x |
| 93000 | Electrocardiogram, complete | 313 | $19.4K | $61.97 | 2.05x |
| 71046 | Chest X-ray, 2 views | 250 | $15.5K | $62.07 | 2.51x |
| 80053 | Comprehensive metabolic panel | 188 | $11.6K | $61.91 | 2.14x |
| 85025 | Complete blood count with differential | 125 | $7.8K | $62.07 | 2.04x |
| 36415 | Venipuncture for blood draw | 63 | $3.9K | $61.59 | 2.38x |
This provider submits charges 2.12 times higher than what Medicare actually pays.
A markup ratio of 2.12x means for every $100 Medicare pays, this provider initially charges $212. 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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