Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 91.4% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #93 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 $1.4M in total Medicare payments ranks in the 98th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 126% 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 | 6.8K | $301.5K | $44.41 | 2.09x |
| 99214 | Office visit, established patient, moderate complexity | 6.1K | $271.4K | $44.40 | 1.78x |
| 99215 | Office visit, established patient, high complexity | 5.4K | $241.2K | $44.40 | 2.11x |
| 99395 | Preventive visit, 18-39 years | 4.8K | $211.1K | $44.40 | 2.35x |
| 99396 | Preventive visit, 40-64 years | 4.1K | $180.9K | $44.40 | 1.69x |
| 93000 | Electrocardiogram, complete | 3.4K | $150.8K | $44.40 | 1.63x |
| 71046 | Chest X-ray, 2 views | 2.7K | $120.6K | $44.40 | 2.28x |
| 80053 | Comprehensive metabolic panel | 2.0K | $90.5K | $44.40 | 2.39x |
| 85025 | Complete blood count with differential | 1.4K | $60.3K | $44.41 | 2.20x |
| 36415 | Venipuncture for blood draw | 679 | $30.2K | $44.41 | 2.40x |
This provider submits charges 2.01 times higher than what Medicare actually pays.
A markup ratio of 2.01x means for every $100 Medicare pays, this provider initially charges $201. 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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