Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 91.4% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #116 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 $891.0K in total Medicare payments ranks in the 95th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 105% 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 | 4.3K | $188.8K | $43.41 | 2.24x |
| 99214 | Office visit, established patient, moderate complexity | 3.9K | $169.9K | $43.41 | 2.66x |
| 99215 | Office visit, established patient, high complexity | 3.5K | $151.0K | $43.42 | 3.20x |
| 99232 | Subsequent hospital care, moderate complexity | 3.0K | $132.1K | $43.41 | 2.53x |
| 99233 | Subsequent hospital care, high complexity | 2.6K | $113.3K | $43.41 | 3.12x |
| 93000 | Electrocardiogram, complete | 2.2K | $94.4K | $43.41 | 2.22x |
| 71046 | Chest X-ray, 2 views | 1.7K | $75.5K | $43.42 | 2.34x |
| 80053 | Comprehensive metabolic panel | 1.3K | $56.6K | $43.43 | 2.70x |
| 85025 | Complete blood count with differential | 870 | $37.8K | $43.39 | 2.48x |
| 36415 | Venipuncture for blood draw | 435 | $18.9K | $43.39 | 2.65x |
This provider submits charges 2.75 times higher than what Medicare actually pays.
A markup ratio of 2.75x means for every $100 Medicare pays, this provider initially charges $275. 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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