Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 88.3% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #337 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 $286.3K in total Medicare payments ranks in the 85th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 114% 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 | 1.5K | $61.9K | $42.47 | 2.30x |
| 99214 | Office visit, established patient, moderate complexity | 1.3K | $55.7K | $42.48 | 2.12x |
| 99215 | Office visit, established patient, high complexity | 1.2K | $49.5K | $42.45 | 2.06x |
| 99232 | Subsequent hospital care, moderate complexity | 1.0K | $43.3K | $42.47 | 2.00x |
| 99233 | Subsequent hospital care, high complexity | 874 | $37.1K | $42.48 | 2.11x |
| 93000 | Electrocardiogram, complete | 729 | $30.9K | $42.44 | 1.83x |
| 71046 | Chest X-ray, 2 views | 583 | $24.8K | $42.45 | 2.04x |
| 80053 | Comprehensive metabolic panel | 437 | $18.6K | $42.48 | 2.50x |
| 85025 | Complete blood count with differential | 291 | $12.4K | $42.53 | 1.91x |
| 36415 | Venipuncture for blood draw | 146 | $6.2K | $42.38 | 2.39x |
This provider submits charges 2.15 times higher than what Medicare actually pays.
A markup ratio of 2.15x means for every $100 Medicare pays, this provider initially charges $215. 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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