Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 94.6% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #7 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 $716.7K in total Medicare payments ranks in the 94th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 133% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
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 | $93.27 | $42.24 | 2.21x | $51.03 | $43.0K | 1.0K | 340 |
| 2015 | $93.31 | $42.26 | 2.21x | $51.05 | $50.2K | 1.2K | 396 |
| 2016 | $93.29 | $42.25 | 2.21x | $51.04 | $57.3K | 1.4K | 453 |
| 2017 | $93.27 | $42.24 | 2.21x | $51.03 | $64.5K | 1.5K | 510 |
| 2018 | $93.31 | $42.26 | 2.21x | $51.05 | $71.7K | 1.7K | 566 |
| 2019 | $93.31 | $42.26 | 2.21x | $51.05 | $71.7K | 1.7K | 566 |
| 2020 | $93.29 | $42.25 | 2.21x | $51.04 | $78.8K | 1.9K | 623 |
| 2021 | $93.31 | $42.26 | 2.21x | $51.05 | $86.0K | 2.0K | 680 |
| 2022 | $93.29 | $42.25 | 2.21x | $51.04 | $93.2K | 2.2K | 736 |
| 2023 | $93.29 | $42.25 | 2.21x | $51.04 | $100.3K | 2.4K | 793 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office visit, 30-39 minutes | 3.7K | $157.7K | $42.25 | 2.13x |
| 99213 | Established patient office visit, 20-29 minutes | 3.1K | $129.0K | $42.25 | 2.49x |
| 99215 | Established patient office visit, 40-54 minutes | 2.4K | $100.3K | $42.25 | 2.03x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 1.7K | $71.7K | $42.26 | 2.46x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 1.4K | $57.3K | $42.25 | 2.27x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 1.2K | $50.2K | $42.26 | 2.38x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 1.0K | $43.0K | $42.24 | 1.91x |
| 99291 | Critical care, first 30-74 minutes | 848 | $35.8K | $42.26 | 2.41x |
| G0463 | Hospital outpatient clinic visit | 848 | $35.8K | $42.26 | 2.18x |
| 99212 | Established patient office visit, 10-19 minutes | 848 | $35.8K | $42.26 | 2.00x |
This provider submits charges 2.21 times higher than what Medicare actually pays.
A markup ratio of 2.21x means for every $100 Medicare pays, this provider initially charges $221. 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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