Statistical flag only — not an accusation of fraud
⚠️ This provider averages 280 services per working day — physically unusual for an individual practitioner
Based on 701.1K total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $8.1M in total Medicare payments ranks in the 98th percentile of Hematology-Oncology providers nationally.
Averaging 280 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 798% from 2014 to 2023.
This provider has been statistically flagged with a risk score of 74/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 696% in 2022
Year-over-year payment surges can indicate changes in practice volume, new services, or billing pattern shifts.
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 | $24.23 | $10.62 | 2.28x | $13.61 | $445.8K | 42.0K | 28 |
| 2015 | $42.76 | $17.75 | 2.41x | $25.01 | $386.4K | 21.8K | 28 |
| 2016 | $30.13 | $11.70 | 2.58x | $18.43 | $467.2K | 39.9K | 26 |
| 2017 | $52.93 | $22.74 | 2.33x | $30.19 | $345.4K | 15.2K | 24 |
| 2018 | $57.64 | $29.39 | 1.96x | $28.25 | $323.3K | 11.0K | 23 |
| 2019 | $29.38 | $13.67 | 2.15x | $15.71 | $412.7K | 30.2K | 22 |
| 2020 | $15.87 | $7.65 | 2.07x | $8.22 | $171.6K | 22.4K | 15 |
| 2021 | $40.93 | $22.00 | 1.86x | $18.93 | $174.6K | 7.9K | 13 |
| 2022 | $49.46 | $10.95 | 4.52x | $38.51 | $1.4M | 127.0K | 50 |
| 2023 | $53.41 | $10.44 | 5.12x | $42.97 | $4.0M | 383.6K | 65 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J9271 | Injection, pembrolizumab, 1 mg | 38.4K | $1.6M | $42.70 | 3.25x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 9.7K | $811.7K | $83.77 | 2.08x |
| J0897 | Injection, denosumab, 1 mg | 51.0K | $771.2K | $15.12 | 3.32x |
| J9144 | Injection, daratumumab, 10 mg and hyaluronidase-fihj | 21.4K | $708.5K | $33.08 | 4.12x |
| J2505 | Injection, pegfilgrastim, 6 mg | 226 | $624.5K | $2.8K | 1.66x |
| 78815 | Nuclear medicine study from skull base to mid-thigh with ct scan | 415 | $521.7K | $1.3K | 3.28x |
| J1568 | Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg | 14.2K | $444.5K | $31.41 | 7.91x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 2.6K | $283.8K | $107.63 | 3.77x |
| J9299 | Injection, nivolumab, 1 mg | 8.2K | $182.6K | $22.27 | 3.68x |
| J0881 | Injection, darbepoetin alfa, 1 microgram (non-esrd use) | 68.6K | $162.8K | $2.37 | 8.84x |
| A9552 | Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries | 434 | $121.8K | $280.61 | 2.27x |
| Q5108 | Injection, pegfilgrastim-jmdb, biosimilar, (fulphila), 0.5 mg | 456 | $110.0K | $241.24 | 1.87x |
| J1930 | Injection, lanreotide, 1 mg | 2.0K | $103.1K | $50.54 | 4.81x |
| J0885 | Injection, epoetin alfa, (for non-esrd use), 1000 units | 10.6K | $100.8K | $9.52 | 2.20x |
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | 1.8K | $100.7K | $57.41 | 1.90x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 799 | $99.7K | $124.82 | 2.18x |
| 96367 | Infusion into a vein for therapy, prevention, or diagnosis, additional sequential infusion, 1 hour or less | 3.5K | $85.6K | $24.19 | 2.85x |
| 96365 | Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less | 1.6K | $84.0K | $52.50 | 3.49x |
| Q5122 | Injection, pegfilgrastim-apgf (nyvepria), biosimilar, 0.5 mg | 780 | $71.6K | $91.81 | 9.57x |
| 96372 | Injection of drug or substance under skin or into muscle | 3.6K | $52.3K | $14.46 | 4.05x |
This provider submits charges 4.06 times higher than what Medicare actually pays.
A markup ratio of 4.06x means for every $100 Medicare pays, this provider initially charges $406. 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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