Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 92.7% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #69 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 $724.8K in total Medicare payments ranks in the 94th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 109% 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 | 2.7K | $156.3K | $58.13 | 1.77x |
| 99214 | Office visit, established patient, moderate complexity | 2.4K | $140.6K | $58.11 | 1.53x |
| 99215 | Office visit, established patient, high complexity | 2.2K | $125.0K | $58.12 | 1.43x |
| 99232 | Subsequent hospital care, moderate complexity | 1.9K | $109.4K | $58.12 | 1.61x |
| 99233 | Subsequent hospital care, high complexity | 1.6K | $93.8K | $58.13 | 1.30x |
| 93000 | Electrocardiogram, complete | 1.3K | $78.1K | $58.13 | 1.41x |
| 71046 | Chest X-ray, 2 views | 1.1K | $62.5K | $58.14 | 1.43x |
| 80053 | Comprehensive metabolic panel | 807 | $46.9K | $58.09 | 1.44x |
| 85025 | Complete blood count with differential | 538 | $31.3K | $58.09 | 1.29x |
| 36415 | Venipuncture for blood draw | 269 | $15.6K | $58.09 | 1.42x |
This provider submits charges 1.57 times higher than what Medicare actually pays.
A markup ratio of 1.57x means for every $100 Medicare pays, this provider initially charges $157. 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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