Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 89.4% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #186 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 $755.4K in total Medicare payments ranks in the 97th percentile of Emergency Medicine providers nationally.
Medicare payments to this provider grew 112% 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 | 3.3K | $162.5K | $48.67 | 2.95x |
| 99214 | Office visit, established patient, moderate complexity | 3.0K | $146.3K | $48.67 | 3.02x |
| 99215 | Office visit, established patient, high complexity | 2.7K | $130.0K | $48.67 | 3.40x |
| 99232 | Subsequent hospital care, moderate complexity | 2.3K | $113.8K | $48.67 | 2.99x |
| 99233 | Subsequent hospital care, high complexity | 2.0K | $97.5K | $48.67 | 4.35x |
| 93000 | Electrocardiogram, complete | 1.7K | $81.3K | $48.67 | 4.01x |
| 71046 | Chest X-ray, 2 views | 1.3K | $65.0K | $48.67 | 4.26x |
| 80053 | Comprehensive metabolic panel | 1.0K | $48.8K | $48.67 | 3.65x |
| 85025 | Complete blood count with differential | 668 | $32.5K | $48.67 | 3.40x |
| 36415 | Venipuncture for blood draw | 334 | $16.3K | $48.67 | 3.76x |
This provider submits charges 3.66 times higher than what Medicare actually pays.
A markup ratio of 3.66x means for every $100 Medicare pays, this provider initially charges $366. 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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