Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 92.0% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #131 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 $335.0K in total Medicare payments ranks in the 87th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 112% 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 | 1.4K | $72.1K | $52.75 | 1.95x |
| 99214 | Office visit, established patient, moderate complexity | 1.2K | $64.9K | $52.77 | 2.09x |
| 99215 | Office visit, established patient, high complexity | 1.1K | $57.6K | $52.74 | 1.95x |
| 99232 | Subsequent hospital care, moderate complexity | 956 | $50.4K | $52.76 | 2.14x |
| 99233 | Subsequent hospital care, high complexity | 819 | $43.2K | $52.79 | 1.78x |
| 93000 | Electrocardiogram, complete | 683 | $36.0K | $52.75 | 2.38x |
| 71046 | Chest X-ray, 2 views | 546 | $28.8K | $52.79 | 2.22x |
| 80053 | Comprehensive metabolic panel | 410 | $21.6K | $52.73 | 1.88x |
| 85025 | Complete blood count with differential | 273 | $14.4K | $52.79 | 1.65x |
| 36415 | Venipuncture for blood draw | 137 | $7.2K | $52.60 | 2.07x |
This provider submits charges 1.98 times higher than what Medicare actually pays.
A markup ratio of 1.98x means for every $100 Medicare pays, this provider initially charges $198. This is lower 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.
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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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