Statistical flag only — not an accusation of fraud
This provider's $1.7M in total Medicare payments ranks in the 90th percentile of Hematology-Oncology providers nationally.
Their average markup ratio of 28.79x is significantly above the specialty median of 3.5x.
Medicare payments to this provider grew 77% from 2014 to 2023.
This provider has been statistically flagged with a risk score of 68/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
Average per-service amounts submitted by the provider compared to what Medicare actually paid — the gap represents the markup.
| Year | Avg Submitted | Avg Paid | Markup Ratio | Gap per Service | Total Payments | Services | Beneficiaries |
|---|---|---|---|---|---|---|---|
| 2014 | $401.33 | $13.94 | 28.79x | $387.39 | $117.4K | 8.4K | 231 |
| 2015 | $401.33 | $13.94 | 28.79x | $387.39 | $127.5K | 9.1K | 251 |
| 2016 | $401.33 | $13.94 | 28.79x | $387.39 | $137.6K | 9.9K | 271 |
| 2017 | $401.33 | $13.94 | 28.79x | $387.39 | $147.6K | 10.6K | 290 |
| 2018 | $401.33 | $13.94 | 28.79x | $387.39 | $157.7K | 11.3K | 310 |
| 2019 | $401.33 | $13.94 | 28.79x | $387.39 | $167.8K | 12.0K | 330 |
| 2020 | $401.33 | $13.94 | 28.79x | $387.39 | $177.8K | 12.8K | 350 |
| 2021 | $401.33 | $13.94 | 28.79x | $387.39 | $187.9K | 13.5K | 370 |
| 2022 | $401.33 | $13.94 | 28.79x | $387.39 | $198.0K | 14.2K | 389 |
| 2023 | $401.33 | $13.94 | 28.79x | $387.39 | $208.0K | 14.9K | 409 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99213 | Office/outpatient visit, est patient, low | 41.1K | $572.8K | $13.94 | 25.77x |
| 99214 | Office/outpatient visit, est patient, moderate | 20.6K | $286.4K | $13.94 | 33.18x |
| 99215 | Office/outpatient visit, est patient, high | 13.7K | $190.9K | $13.94 | 34.28x |
| 99223 | Initial hospital care, high complexity | 10.3K | $143.2K | $13.94 | 28.98x |
| 99232 | Subsequent hospital care, moderate | 8.2K | $114.6K | $13.94 | 33.22x |
| 93000 | Electrocardiogram, complete | 6.8K | $95.5K | $13.94 | 26.69x |
| 71046 | Chest X-ray, 2 views | 5.9K | $81.8K | $13.93 | 23.17x |
| 80053 | Comprehensive metabolic panel | 5.1K | $71.6K | $13.93 | 23.39x |
| 85025 | Complete blood count (CBC) | 4.6K | $63.6K | $13.94 | 33.09x |
| 36415 | Venipuncture | 4.1K | $57.3K | $13.94 | 30.14x |
This provider submits charges 28.79 times higher than what Medicare actually pays.
A markup ratio of 28.79x means for every $100 Medicare pays, this provider initially charges $2879. 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.
Other Hematology-Oncology providers in VA for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Thomas Alberico, MD | Norfolk, VA | $38.5M | ⚠️ Flagged |
| Mark Fleming, MD | Hampton, VA | $37.6M | ⚠️ Flagged |
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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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