Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 88.4% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #447 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 $86.3K in total Medicare payments ranks in the 51th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 109% 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 | 370 | $18.5K | $49.95 | 2.63x |
| 99214 | Office visit, established patient, moderate complexity | 333 | $16.6K | $49.95 | 1.98x |
| 99215 | Office visit, established patient, high complexity | 296 | $14.8K | $49.95 | 1.87x |
| 99232 | Subsequent hospital care, moderate complexity | 259 | $12.9K | $49.95 | 2.54x |
| 99233 | Subsequent hospital care, high complexity | 222 | $11.1K | $49.95 | 2.14x |
| 93000 | Electrocardiogram, complete | 185 | $9.2K | $49.95 | 1.94x |
| 71046 | Chest X-ray, 2 views | 148 | $7.4K | $49.95 | 2.53x |
| 80053 | Comprehensive metabolic panel | 111 | $5.5K | $49.95 | 2.40x |
| 85025 | Complete blood count with differential | 74 | $3.7K | $49.96 | 1.88x |
| 36415 | Venipuncture for blood draw | 37 | $1.8K | $49.95 | 2.68x |
This provider submits charges 2.27 times higher than what Medicare actually pays.
A markup ratio of 2.27x means for every $100 Medicare pays, this provider initially charges $227. 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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