Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 91.8% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #81 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 $1.6M in total Medicare payments ranks in the 97th percentile of Geriatric Medicine providers nationally.
Medicare payments to this provider grew 115% 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 | 5.1K | $336.5K | $66.37 | 2.96x |
| 99214 | Office visit, established patient, moderate complexity | 4.6K | $302.8K | $66.37 | 2.99x |
| 99215 | Office visit, established patient, high complexity | 4.1K | $269.2K | $66.37 | 2.33x |
| 99232 | Subsequent hospital care, moderate complexity | 3.5K | $235.5K | $66.37 | 2.32x |
| 99233 | Subsequent hospital care, high complexity | 3.0K | $201.9K | $66.36 | 2.69x |
| 93000 | Electrocardiogram, complete | 2.5K | $168.2K | $66.36 | 3.14x |
| 71046 | Chest X-ray, 2 views | 2.0K | $134.6K | $66.36 | 2.94x |
| 80053 | Comprehensive metabolic panel | 1.5K | $100.9K | $66.36 | 2.17x |
| 85025 | Complete blood count with differential | 1.0K | $67.3K | $66.36 | 3.21x |
| 36415 | Venipuncture for blood draw | 507 | $33.6K | $66.36 | 2.28x |
This provider submits charges 2.7 times higher than what Medicare actually pays.
A markup ratio of 2.7x means for every $100 Medicare pays, this provider initially charges $270. 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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