Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 95.9% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #1 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 $788.7K in total Medicare payments ranks in the 95th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 133% from 2014 to 2023.
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 | $119.69 | $52.52 | 2.28x | $67.17 | $47.3K | 901 | 369 |
| 2015 | $119.72 | $52.53 | 2.28x | $67.19 | $55.2K | 1.1K | 430 |
| 2016 | $119.62 | $52.49 | 2.28x | $67.13 | $63.1K | 1.2K | 491 |
| 2017 | $119.65 | $52.50 | 2.28x | $67.15 | $71.0K | 1.4K | 553 |
| 2018 | $119.67 | $52.51 | 2.28x | $67.16 | $78.9K | 1.5K | 614 |
| 2019 | $119.67 | $52.51 | 2.28x | $67.16 | $78.9K | 1.5K | 614 |
| 2020 | $119.67 | $52.51 | 2.28x | $67.16 | $86.8K | 1.7K | 676 |
| 2021 | $119.62 | $52.49 | 2.28x | $67.13 | $94.6K | 1.8K | 737 |
| 2022 | $119.65 | $52.50 | 2.28x | $67.15 | $102.5K | 2.0K | 799 |
| 2023 | $119.65 | $52.50 | 2.28x | $67.15 | $110.4K | 2.1K | 860 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office visit, 30-39 minutes | 3.3K | $173.5K | $52.50 | 2.12x |
| 99213 | Established patient office visit, 20-29 minutes | 2.7K | $142.0K | $52.50 | 1.96x |
| 99215 | Established patient office visit, 40-54 minutes | 2.1K | $110.4K | $52.50 | 2.32x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 1.5K | $78.9K | $52.51 | 2.61x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 1.2K | $63.1K | $52.49 | 2.09x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 1.1K | $55.2K | $52.53 | 2.11x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 901 | $47.3K | $52.52 | 2.46x |
| 99291 | Critical care, first 30-74 minutes | 751 | $39.4K | $52.51 | 1.95x |
| G0463 | Hospital outpatient clinic visit | 751 | $39.4K | $52.51 | 2.13x |
| 99212 | Established patient office visit, 10-19 minutes | 751 | $39.4K | $52.51 | 2.19x |
This provider submits charges 2.28 times higher than what Medicare actually pays.
A markup ratio of 2.28x means for every $100 Medicare pays, this provider initially charges $228. 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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