Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 94.2% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #18 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 $577.3K in total Medicare payments ranks in the 95th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 110% 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 | 2.2K | $126.3K | $57.74 | 2.16x |
| 99214 | Office visit, established patient, moderate complexity | 2.0K | $113.7K | $57.72 | 2.19x |
| 99215 | Office visit, established patient, high complexity | 1.8K | $101.1K | $57.72 | 2.49x |
| 99395 | Preventive visit, 18-39 years | 1.5K | $88.4K | $57.73 | 2.15x |
| 99396 | Preventive visit, 40-64 years | 1.3K | $75.8K | $57.73 | 2.63x |
| 93000 | Electrocardiogram, complete | 1.1K | $63.2K | $57.74 | 2.51x |
| 71046 | Chest X-ray, 2 views | 875 | $50.5K | $57.76 | 2.64x |
| 80053 | Comprehensive metabolic panel | 657 | $37.9K | $57.69 | 2.29x |
| 85025 | Complete blood count with differential | 438 | $25.3K | $57.69 | 2.05x |
| 36415 | Venipuncture for blood draw | 219 | $12.6K | $57.69 | 2.37x |
This provider submits charges 2.24 times higher than what Medicare actually pays.
A markup ratio of 2.24x means for every $100 Medicare pays, this provider initially charges $224. 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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