Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 91.1% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #224 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 $56.4K in total Medicare payments ranks in the 51th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 97% 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 | 226 | $12.4K | $54.89 | 1.80x |
| 99214 | Office visit, established patient, moderate complexity | 203 | $11.2K | $55.00 | 1.64x |
| 99215 | Office visit, established patient, high complexity | 181 | $9.9K | $54.83 | 1.48x |
| 99395 | Preventive visit, 18-39 years | 158 | $8.7K | $54.96 | 1.70x |
| 99396 | Preventive visit, 40-64 years | 135 | $7.4K | $55.13 | 1.67x |
| 93000 | Electrocardiogram, complete | 113 | $6.2K | $54.89 | 2.01x |
| 71046 | Chest X-ray, 2 views | 90 | $5.0K | $55.13 | 1.96x |
| 80053 | Comprehensive metabolic panel | 68 | $3.7K | $54.74 | 1.76x |
| 85025 | Complete blood count with differential | 45 | $2.5K | $55.13 | 2.19x |
| 36415 | Venipuncture for blood draw | 23 | $1.2K | $53.96 | 1.59x |
This provider submits charges 1.84 times higher than what Medicare actually pays.
A markup ratio of 1.84x means for every $100 Medicare pays, this provider initially charges $184. This is lower 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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