Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 89.3% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #313 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 $261.7K in total Medicare payments ranks in the 84th percentile of Geriatric 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 | $56.8K | $48.20 | 2.80x |
| 99214 | Office visit, established patient, moderate complexity | 1.1K | $51.1K | $48.20 | 2.41x |
| 99215 | Office visit, established patient, high complexity | 943 | $45.5K | $48.21 | 2.11x |
| 99232 | Subsequent hospital care, moderate complexity | 825 | $39.8K | $48.22 | 2.40x |
| 99233 | Subsequent hospital care, high complexity | 707 | $34.1K | $48.23 | 2.08x |
| 93000 | Electrocardiogram, complete | 589 | $28.4K | $48.24 | 2.49x |
| 71046 | Chest X-ray, 2 views | 472 | $22.7K | $48.16 | 1.98x |
| 80053 | Comprehensive metabolic panel | 354 | $17.0K | $48.16 | 2.51x |
| 85025 | Complete blood count with differential | 236 | $11.4K | $48.16 | 2.49x |
| 36415 | Venipuncture for blood draw | 118 | $5.7K | $48.16 | 2.07x |
This provider submits charges 2.34 times higher than what Medicare actually pays.
A markup ratio of 2.34x means for every $100 Medicare pays, this provider initially charges $234. 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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