Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 89.0% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #256 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 $271.5K in total Medicare payments ranks in the 85th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 100% 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 | 1.2K | $58.5K | $48.90 | 1.76x |
| 99214 | Office visit, established patient, moderate complexity | 1.1K | $52.7K | $48.86 | 1.98x |
| 99215 | Office visit, established patient, high complexity | 958 | $46.8K | $48.88 | 1.87x |
| 99232 | Subsequent hospital care, moderate complexity | 838 | $41.0K | $48.89 | 1.54x |
| 99233 | Subsequent hospital care, high complexity | 718 | $35.1K | $48.91 | 1.55x |
| 93000 | Electrocardiogram, complete | 599 | $29.3K | $48.86 | 1.77x |
| 71046 | Chest X-ray, 2 views | 479 | $23.4K | $48.88 | 1.46x |
| 80053 | Comprehensive metabolic panel | 359 | $17.6K | $48.91 | 1.86x |
| 85025 | Complete blood count with differential | 239 | $11.7K | $48.98 | 1.81x |
| 36415 | Venipuncture for blood draw | 120 | $5.9K | $48.77 | 1.68x |
This provider submits charges 1.7 times higher than what Medicare actually pays.
A markup ratio of 1.7x means for every $100 Medicare pays, this provider initially charges $170. This is lower 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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