Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 88.5% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #327 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 $284.4K in total Medicare payments ranks in the 85th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 122% 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 | 1.2K | $63.1K | $52.17 | 2.18x |
| 99214 | Office visit, established patient, moderate complexity | 1.1K | $56.8K | $52.17 | 2.11x |
| 99215 | Office visit, established patient, high complexity | 967 | $50.5K | $52.18 | 2.04x |
| 99232 | Subsequent hospital care, moderate complexity | 846 | $44.1K | $52.19 | 2.72x |
| 99233 | Subsequent hospital care, high complexity | 725 | $37.8K | $52.20 | 2.61x |
| 93000 | Electrocardiogram, complete | 604 | $31.5K | $52.21 | 2.81x |
| 71046 | Chest X-ray, 2 views | 483 | $25.2K | $52.23 | 2.90x |
| 80053 | Comprehensive metabolic panel | 363 | $18.9K | $52.12 | 2.10x |
| 85025 | Complete blood count with differential | 242 | $12.6K | $52.12 | 2.66x |
| 36415 | Venipuncture for blood draw | 121 | $6.3K | $52.12 | 2.09x |
This provider submits charges 2.43 times higher than what Medicare actually pays.
A markup ratio of 2.43x means for every $100 Medicare pays, this provider initially charges $243. 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.
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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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