Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 88.5% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #248 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 $200.0K in total Medicare payments ranks in the 79th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 121% 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 | 1.1K | $42.8K | $39.75 | 2.14x |
| 99214 | Office visit, established patient, moderate complexity | 969 | $38.5K | $39.73 | 2.06x |
| 99215 | Office visit, established patient, high complexity | 861 | $34.2K | $39.74 | 1.62x |
| 99232 | Subsequent hospital care, moderate complexity | 753 | $29.9K | $39.76 | 1.71x |
| 99233 | Subsequent hospital care, high complexity | 646 | $25.7K | $39.73 | 2.12x |
| 93000 | Electrocardiogram, complete | 538 | $21.4K | $39.75 | 1.98x |
| 71046 | Chest X-ray, 2 views | 431 | $17.1K | $39.70 | 1.76x |
| 80053 | Comprehensive metabolic panel | 323 | $12.8K | $39.72 | 1.68x |
| 85025 | Complete blood count with differential | 215 | $8.6K | $39.79 | 2.19x |
| 36415 | Venipuncture for blood draw | 108 | $4.3K | $39.60 | 1.81x |
This provider submits charges 1.9 times higher than what Medicare actually pays.
A markup ratio of 1.9x means for every $100 Medicare pays, this provider initially charges $190. This is lower than the national average.
Always verify provider credentials and location before scheduling appointments. This data reflects Medicare payments and may not include all practice locations.
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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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