Statistical flag only — not an accusation of fraud
This provider's $39.7M in total Medicare payments ranks in the 99th percentile of All Other Suppliers providers nationally.
Their average markup ratio of 6.48x is significantly above the specialty median of 2.2x.
88% of their billing comes from a single procedure code (L9900 — Orthotic and prosthetic supply, accessory, and/or service component of another hcpcs "l" code).
This provider has been statistically flagged with a risk score of 75/100. 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 | $205.80 | $33.81 | 6.09x | $171.99 | $3.5M | 103.7K | 2 |
| 2015 | $225.12 | $35.26 | 6.38x | $189.86 | $3.4M | 96.5K | 1 |
| 2016 | $224.75 | $35.29 | 6.37x | $189.46 | $3.8M | 107.6K | 1 |
| 2017 | $224.89 | $34.60 | 6.50x | $190.29 | $4.1M | 118.0K | 1 |
| 2018 | $229.41 | $35.29 | 6.50x | $194.12 | $4.3M | 120.8K | 1 |
| 2019 | $229.43 | $35.25 | 6.51x | $194.18 | $4.1M | 116.3K | 1 |
| 2020 | $235.12 | $35.74 | 6.58x | $199.38 | $4.2M | 118.4K | 1 |
| 2021 | $238.67 | $35.95 | 6.64x | $202.72 | $4.1M | 115.0K | 1 |
| 2022 | $250.13 | $35.52 | 7.04x | $214.61 | $3.8M | 107.2K | 1 |
| 2023 | $269.91 | $43.92 | 6.15x | $225.99 | $4.4M | 99.4K | 2 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| L9900 | Orthotic and prosthetic supply, accessory, and/or service component of another hcpcs "l" code | 990.9K | $35.0M | $35.36 | 6.55x |
| A7048 | Vacuum drainage collection unit and tubing kit, including all supplies needed for collection unit change, for use with implanted catheter, each | 98.3K | $4.3M | $44.02 | 6.13x |
| A7043 | Vacuum drainage bottle and tubing for use with implanted catheter | 13.6K | $317.1K | $23.32 | 3.46x |
This provider submits charges 6.48 times higher than what Medicare actually pays.
A markup ratio of 6.48x means for every $100 Medicare pays, this provider initially charges $648. 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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