Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 90.1% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #180 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 $644.5K in total Medicare payments ranks in the 80th percentile of Medical Oncology providers nationally.
Medicare payments to this provider grew 98% 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 | $137.5K | $41.34 | 3.63x |
| 99214 | Office visit, established patient, moderate complexity | 3.0K | $123.8K | $41.35 | 3.74x |
| 99215 | Office visit, established patient, high complexity | 2.7K | $110.0K | $41.35 | 2.71x |
| 99232 | Subsequent hospital care, moderate complexity | 2.3K | $96.3K | $41.34 | 3.40x |
| 99233 | Subsequent hospital care, high complexity | 2.0K | $82.5K | $41.35 | 2.75x |
| 93000 | Electrocardiogram, complete | 1.7K | $68.8K | $41.35 | 3.48x |
| 71046 | Chest X-ray, 2 views | 1.3K | $55.0K | $41.34 | 3.11x |
| 80053 | Comprehensive metabolic panel | 998 | $41.3K | $41.35 | 3.50x |
| 85025 | Complete blood count with differential | 665 | $27.5K | $41.37 | 4.02x |
| 36415 | Venipuncture for blood draw | 333 | $13.8K | $41.30 | 3.41x |
This provider submits charges 3.38 times higher than what Medicare actually pays.
A markup ratio of 3.38x means for every $100 Medicare pays, this provider initially charges $338. 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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