Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 87.6% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #451 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 $633.2K in total Medicare payments ranks in the 93th percentile of Infectious Disease providers nationally.
Medicare payments to this provider grew 97% 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 | 2.3K | $135.7K | $58.23 | 3.45x |
| 99214 | Office visit, established patient, moderate complexity | 2.1K | $122.1K | $58.23 | 3.12x |
| 99215 | Office visit, established patient, high complexity | 1.9K | $108.5K | $58.23 | 3.60x |
| 99232 | Subsequent hospital care, moderate complexity | 1.6K | $95.0K | $58.23 | 2.97x |
| 99233 | Subsequent hospital care, high complexity | 1.4K | $81.4K | $58.23 | 3.02x |
| 93000 | Electrocardiogram, complete | 1.2K | $67.8K | $58.23 | 3.99x |
| 71046 | Chest X-ray, 2 views | 932 | $54.3K | $58.23 | 2.92x |
| 80053 | Comprehensive metabolic panel | 699 | $40.7K | $58.23 | 4.21x |
| 85025 | Complete blood count with differential | 466 | $27.1K | $58.23 | 4.07x |
| 36415 | Venipuncture for blood draw | 233 | $13.6K | $58.23 | 3.67x |
This provider submits charges 3.56 times higher than what Medicare actually pays.
A markup ratio of 3.56x means for every $100 Medicare pays, this provider initially charges $356. 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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