Statistical flag only — not an accusation of fraud
⚠️ This provider averages 655 services per working day — physically unusual for an individual practitioner
Based on 1.6M total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $21.3M in total Medicare payments ranks in the 99th percentile of Hematology-Oncology providers nationally.
Averaging 655 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 157% from 2014 to 2023.
This provider has been statistically flagged with a risk score of 66/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 59% in 2023
Year-over-year payment surges can indicate changes in practice volume, new services, or billing pattern shifts.
Average per-service amounts submitted by the provider compared to what Medicare actually paid — the gap represents the markup.
| Year | Avg Submitted | Avg Paid | Markup Ratio | Gap per Service | Total Payments | Services | Beneficiaries |
|---|---|---|---|---|---|---|---|
| 2014 | $51.35 | $17.17 | 2.99x | $34.18 | $1.7M | 96.2K | 35 |
| 2015 | $43.91 | $14.75 | 2.98x | $29.16 | $1.9M | 129.2K | 31 |
| 2016 | $44.10 | $18.30 | 2.41x | $25.80 | $1.5M | 80.6K | 28 |
| 2017 | $55.21 | $19.82 | 2.79x | $35.39 | $1.3M | 65.6K | 31 |
| 2018 | $42.76 | $13.22 | 3.23x | $29.54 | $1.8M | 136.6K | 34 |
| 2019 | $60.49 | $11.43 | 5.29x | $49.06 | $2.0M | 176.7K | 38 |
| 2020 | $59.33 | $11.67 | 5.08x | $47.66 | $1.9M | 165.2K | 36 |
| 2021 | $57.82 | $11.35 | 5.09x | $46.47 | $2.3M | 202.2K | 39 |
| 2022 | $59.48 | $11.44 | 5.20x | $48.04 | $2.7M | 233.3K | 35 |
| 2023 | $57.17 | $12.03 | 4.75x | $45.14 | $4.2M | 353.0K | 40 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0897 | Injection, denosumab, 1 mg | 245.9K | $3.8M | $15.53 | 5.72x |
| J2505 | Injection, pegfilgrastim, 6 mg | 802 | $2.4M | $3.0K | 1.81x |
| J3111 | Injection, romosozumab-aqqg, 1 mg | 256.2K | $1.9M | $7.59 | 3.16x |
| J1561 | Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg | 46.1K | $1.7M | $37.04 | 4.29x |
| J9310 | Injection, rituximab, 100 mg | 2.7K | $1.7M | $621.41 | 2.11x |
| J0517 | Injection, benralizumab, 1 mg | 9.2K | $1.2M | $126.35 | 3.33x |
| J9312 | Injection, rituximab, 10 mg | 13.1K | $965.7K | $73.83 | 2.80x |
| J9144 | Injection, daratumumab, 10 mg and hyaluronidase-fihj | 18.7K | $709.6K | $37.91 | 2.27x |
| J0885 | Injection, epoetin alfa, (for non-esrd use), 1000 units | 71.1K | $640.3K | $9.01 | 6.53x |
| J9041 | Injection, bortezomib, 0.1 mg | 20.1K | $513.2K | $25.55 | 10.72x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 3.8K | $484.3K | $127.59 | 4.00x |
| J1568 | Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg | 16.1K | $475.9K | $29.50 | 5.96x |
| 99212 | Established patient office or other outpatient visit, 10-19 minutes | 7.9K | $343.6K | $43.56 | 4.00x |
| J2469 | Injection, palonosetron hcl, 25 mcg | 28.2K | $340.7K | $12.09 | 5.58x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 3.1K | $311.3K | $100.65 | 3.99x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 4.5K | $301.8K | $67.73 | 3.40x |
| Q5115 | Injection, rituximab-abbs, biosimilar, (truxima), 10 mg | 6.7K | $279.0K | $41.77 | 3.35x |
| 96365 | Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less | 4.3K | $277.5K | $64.60 | 4.52x |
| J9264 | Injection, paclitaxel protein-bound particles, 1 mg | 35.0K | $267.3K | $7.64 | 2.23x |
| Q5106 | Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units | 40.0K | $263.5K | $6.58 | 6.67x |
This provider submits charges 4.22 times higher than what Medicare actually pays.
A markup ratio of 4.22x means for every $100 Medicare pays, this provider initially charges $422. 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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