Statistical flag only — not an accusation of fraud
This provider's $1.6M in total Medicare payments ranks in the 89th percentile of Hematology-Oncology providers nationally.
Their average markup ratio of 21.75x 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 66/100. 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 | $302.98 | $13.93 | 21.75x | $289.05 | $110.3K | 7.9K | 350 |
| 2015 | $302.98 | $13.93 | 21.75x | $289.05 | $119.7K | 8.6K | 379 |
| 2016 | $302.98 | $13.93 | 21.75x | $289.05 | $129.2K | 9.3K | 409 |
| 2017 | $302.98 | $13.93 | 21.75x | $289.05 | $138.6K | 9.9K | 439 |
| 2018 | $302.98 | $13.93 | 21.75x | $289.05 | $148.1K | 10.6K | 469 |
| 2019 | $302.98 | $13.93 | 21.75x | $289.05 | $157.5K | 11.3K | 499 |
| 2020 | $302.98 | $13.93 | 21.75x | $289.05 | $167.0K | 12.0K | 529 |
| 2021 | $302.98 | $13.93 | 21.75x | $289.05 | $176.4K | 12.7K | 559 |
| 2022 | $302.98 | $13.93 | 21.75x | $289.05 | $185.9K | 13.3K | 589 |
| 2023 | $302.98 | $13.93 | 21.75x | $289.05 | $195.3K | 14.0K | 619 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99213 | Office/outpatient visit, est patient, low | 38.6K | $537.8K | $13.93 | 22.00x |
| 99214 | Office/outpatient visit, est patient, moderate | 19.3K | $268.9K | $13.93 | 23.36x |
| 99215 | Office/outpatient visit, est patient, high | 12.9K | $179.3K | $13.93 | 18.92x |
| 99223 | Initial hospital care, high complexity | 9.6K | $134.4K | $13.93 | 24.88x |
| 99232 | Subsequent hospital care, moderate | 7.7K | $107.6K | $13.93 | 25.82x |
| 93000 | Electrocardiogram, complete | 6.4K | $89.6K | $13.93 | 21.96x |
| 71046 | Chest X-ray, 2 views | 5.5K | $76.8K | $13.93 | 18.87x |
| 80053 | Comprehensive metabolic panel | 4.8K | $67.2K | $13.93 | 18.28x |
| 85025 | Complete blood count (CBC) | 4.3K | $59.8K | $13.93 | 23.49x |
| 36415 | Venipuncture | 3.9K | $53.8K | $13.93 | 21.97x |
This provider submits charges 21.75 times higher than what Medicare actually pays.
A markup ratio of 21.75x means for every $100 Medicare pays, this provider initially charges $2175. 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 TX for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Benjamin Downie, MD | Georgetown, TX | $36.6M | ✓ Clear |
| Mohsen Arani, MD | The Woodlands, TX | $34.3M | ✓ Clear |
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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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