Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 91.5% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #122 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 $967.4K in total Medicare payments ranks in the 96th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 113% 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 | 3.7K | $212.5K | $57.56 | 1.92x |
| 99214 | Office visit, established patient, moderate complexity | 3.3K | $191.3K | $57.56 | 2.02x |
| 99215 | Office visit, established patient, high complexity | 3.0K | $170.0K | $57.55 | 1.53x |
| 99232 | Subsequent hospital care, moderate complexity | 2.6K | $148.8K | $57.55 | 1.73x |
| 99233 | Subsequent hospital care, high complexity | 2.2K | $127.5K | $57.57 | 2.09x |
| 93000 | Electrocardiogram, complete | 1.8K | $106.3K | $57.56 | 2.23x |
| 71046 | Chest X-ray, 2 views | 1.5K | $85.0K | $57.55 | 2.20x |
| 80053 | Comprehensive metabolic panel | 1.1K | $63.8K | $57.54 | 1.97x |
| 85025 | Complete blood count with differential | 738 | $42.5K | $57.59 | 2.08x |
| 36415 | Venipuncture for blood draw | 369 | $21.3K | $57.59 | 1.90x |
This provider submits charges 1.87 times higher than what Medicare actually pays.
A markup ratio of 1.87x means for every $100 Medicare pays, this provider initially charges $187. This is lower 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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