Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 88.2% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #272 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 $67.7K in total Medicare payments ranks in the 40th percentile of Internal 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 | 289 | $14.4K | $49.88 | 1.70x |
| 99214 | Office visit, established patient, moderate complexity | 260 | $13.0K | $49.89 | 2.00x |
| 99215 | Office visit, established patient, high complexity | 231 | $11.5K | $49.92 | 1.96x |
| 99232 | Subsequent hospital care, moderate complexity | 202 | $10.1K | $49.95 | 1.68x |
| 99233 | Subsequent hospital care, high complexity | 173 | $8.6K | $49.99 | 2.02x |
| 93000 | Electrocardiogram, complete | 144 | $7.2K | $50.05 | 1.85x |
| 71046 | Chest X-ray, 2 views | 115 | $5.8K | $50.14 | 1.78x |
| 80053 | Comprehensive metabolic panel | 87 | $4.3K | $49.70 | 1.72x |
| 85025 | Complete blood count with differential | 58 | $2.9K | $49.71 | 1.71x |
| 36415 | Venipuncture for blood draw | 29 | $1.4K | $49.69 | 1.91x |
This provider submits charges 2.04 times higher than what Medicare actually pays.
A markup ratio of 2.04x means for every $100 Medicare pays, this provider initially charges $204. 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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