Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 90.9% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #202 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 $160.3K in total Medicare payments ranks in the 73th percentile of Neurology providers nationally.
Medicare payments to this provider grew 119% 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 | 586 | $34.2K | $58.31 | 2.38x |
| 99214 | Office visit, established patient, moderate complexity | 527 | $30.8K | $58.35 | 2.29x |
| 99215 | Office visit, established patient, high complexity | 469 | $27.3K | $58.28 | 2.40x |
| 99232 | Subsequent hospital care, moderate complexity | 410 | $23.9K | $58.33 | 1.84x |
| 99233 | Subsequent hospital care, high complexity | 352 | $20.5K | $58.24 | 1.79x |
| 93000 | Electrocardiogram, complete | 293 | $17.1K | $58.31 | 1.72x |
| 71046 | Chest X-ray, 2 views | 234 | $13.7K | $58.41 | 2.09x |
| 80053 | Comprehensive metabolic panel | 176 | $10.3K | $58.24 | 2.17x |
| 85025 | Complete blood count with differential | 117 | $6.8K | $58.40 | 2.26x |
| 36415 | Venipuncture for blood draw | 59 | $3.4K | $57.92 | 1.92x |
This provider submits charges 2.12 times higher than what Medicare actually pays.
A markup ratio of 2.12x means for every $100 Medicare pays, this provider initially charges $212. 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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