Statistical flag only — not an accusation of fraud
⚠️ This provider averages 742 services per working day — physically unusual for an individual practitioner
Based on 1.9M total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $21.9M in total Medicare payments ranks in the 99th percentile of Pathology providers nationally.
Their average markup ratio of 5.85x is significantly above the specialty median of 4.6x.
Averaging 742 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 21199% 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 18333% in 2021
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 | $199.53 | $26.90 | 7.42x | $172.63 | $36.1K | 1.3K | 15 |
| 2015 | $205.80 | $26.40 | 7.80x | $179.40 | $43.3K | 1.6K | 12 |
| 2016 | $196.19 | $28.57 | 6.87x | $167.62 | $41.5K | 1.5K | 14 |
| 2017 | $196.16 | $28.38 | 6.91x | $167.78 | $43.3K | 1.5K | 13 |
| 2018 | $203.18 | $28.55 | 7.12x | $174.63 | $37.8K | 1.3K | 14 |
| 2019 | $208.40 | $28.93 | 7.20x | $179.47 | $42.9K | 1.5K | 16 |
| 2020 | $214.63 | $30.87 | 6.95x | $183.76 | $33.3K | 1.1K | 13 |
| 2021 | $62.36 | $12.05 | 5.18x | $50.31 | $6.1M | 510.2K | 115 |
| 2022 | $67.26 | $12.00 | 5.61x | $55.26 | $7.8M | 651.8K | 123 |
| 2023 | $74.09 | $11.24 | 6.59x | $62.85 | $7.7M | 683.8K | 120 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 80053 | Blood test, comprehensive group of blood chemicals | 287.3K | $3.0M | $10.41 | 7.68x |
| 84443 | Blood test, thyroid stimulating hormone (tsh) | 177.7K | $2.9M | $16.57 | 5.62x |
| 80061 | Blood test, lipids (cholesterol and triglycerides) | 219.1K | $2.9M | $13.20 | 6.29x |
| 82306 | Vitamin d-3 level | 70.5K | $2.1M | $29.17 | 4.70x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | 242.9K | $1.9M | $7.66 | 5.07x |
| 83036 | Hemoglobin a1c level | 122.6K | $1.2M | $9.56 | 5.21x |
| U0003 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r | 9.0K | $674.6K | $74.67 | 2.31x |
| 84439 | Thyroxine (thyroid chemical), free | 48.6K | $431.6K | $8.89 | 7.77x |
| G0103 | Prostate cancer screening; prostate specific antigen test (psa) | 22.1K | $420.3K | $19.05 | 2.44x |
| 82607 | Cyanocobalamin (vitamin b-12) level | 24.7K | $366.4K | $14.85 | 5.61x |
| 82043 | Urine microalbumin (protein) level | 64.3K | $364.9K | $5.68 | 8.98x |
| 84153 | Psa (prostate specific antigen) measurement, total | 20.1K | $364.2K | $18.15 | 5.30x |
| 83970 | Parathormone (parathyroid hormone) level | 8.6K | $348.7K | $40.59 | 4.30x |
| 82570 | Creatinine level to test for kidney function or muscle injury | 64.9K | $330.6K | $5.09 | 11.00x |
| 83880 | Natriuretic peptide (heart and blood vessel protein) level | 8.2K | $315.7K | $38.58 | 4.85x |
| 87086 | Bacterial colony count, urine | 39.0K | $310.7K | $7.96 | 4.78x |
| 80048 | Blood test, basic group of blood chemicals (calcium, total) | 37.0K | $309.0K | $8.34 | 7.79x |
| 82728 | Ferritin (blood protein) level | 18.4K | $246.8K | $13.42 | 5.42x |
| U0005 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within | 9.0K | $223.4K | $24.90 | 2.01x |
| 87186 | Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution | 21.2K | $180.5K | $8.53 | 5.03x |
This provider submits charges 5.85 times higher than what Medicare actually pays.
A markup ratio of 5.85x means for every $100 Medicare pays, this provider initially charges $585. 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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