Statistical flag only — not an accusation of fraud
⚠️ This provider averages 1.2K services per working day — physically unusual for an individual practitioner
Based on 2.6M total services over 9 years (250 working days/year). Learn about impossible service volumes →
This provider's $22.3M in total Medicare payments ranks in the 99th percentile of Hematology-Oncology providers nationally.
Averaging 1.2K services per working day raises questions about billing patterns.
Medicare payments to this provider grew 1222% from 2015 to 2023.
This provider has been statistically flagged with a risk score of 70/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 339% in 2016
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 |
|---|---|---|---|---|---|---|---|
| 2015 | $23.05 | $9.51 | 2.42x | $13.54 | $250.6K | 26.4K | 36 |
| 2016 | $21.29 | $8.25 | 2.58x | $13.04 | $1.1M | 133.4K | 57 |
| 2017 | $26.59 | $9.73 | 2.73x | $16.86 | $924.3K | 95.0K | 59 |
| 2018 | $37.42 | $8.32 | 4.50x | $29.10 | $2.3M | 270.5K | 79 |
| 2019 | $32.74 | $7.80 | 4.20x | $24.94 | $3.6M | 461.9K | 87 |
| 2020 | $39.57 | $9.22 | 4.29x | $30.35 | $3.4M | 372.2K | 83 |
| 2021 | $37.61 | $7.53 | 4.99x | $30.08 | $3.5M | 460.3K | 90 |
| 2022 | $39.65 | $8.56 | 4.63x | $31.09 | $4.0M | 467.6K | 82 |
| 2023 | $42.72 | $9.87 | 4.33x | $32.85 | $3.3M | 335.7K | 86 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J9271 | Injection, pembrolizumab, 1 mg | 119.0K | $4.8M | $40.68 | 2.28x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 14.7K | $1.5M | $105.00 | 3.59x |
| J0897 | Injection, denosumab, 1 mg | 89.3K | $1.4M | $15.94 | 4.80x |
| 88185 | Flow cytometry technique for dna or cell analysis, each additional marker | 48.2K | $1.4M | $28.47 | 4.14x |
| J1439 | Injection, ferric carboxymaltose, 1 mg | 1.0M | $901.3K | $0.86 | 6.73x |
| J1568 | Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg | 23.1K | $748.2K | $32.34 | 3.40x |
| J2796 | Injection, romiplostim, 10 micrograms | 12.1K | $716.3K | $59.03 | 2.38x |
| J2505 | Injection, pegfilgrastim, 6 mg | 214 | $691.8K | $3.2K | 4.03x |
| J9035 | Injection, bevacizumab, 10 mg | 10.6K | $660.9K | $62.41 | 2.08x |
| 99215 | Established patient office or other outpatient visit, 40-54 minutes | 4.1K | $627.7K | $151.48 | 5.74x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 4.0K | $539.1K | $136.44 | 3.74x |
| J0881 | Injection, darbepoetin alfa, 1 microgram (non-esrd use) | 193.5K | $520.8K | $2.69 | 7.43x |
| J9145 | Injection, daratumumab, 10 mg | 12.0K | $512.6K | $42.71 | 2.11x |
| J9299 | Injection, nivolumab, 1 mg | 21.4K | $491.8K | $22.96 | 2.61x |
| J1454 | Injection, fosnetupitant 235 mg and palonosetron 0.25 mg | 1.1K | $432.0K | $387.14 | 4.70x |
| 99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | 4.3K | $412.0K | $95.61 | 3.62x |
| J0885 | Injection, epoetin alfa, (for non-esrd use), 1000 units | 34.4K | $337.2K | $9.80 | 4.47x |
| 99490 | Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month | 6.5K | $295.5K | $45.47 | 2.82x |
| 99205 | New patient office or other outpatient visit, 60-74 minutes | 1.4K | $260.5K | $189.42 | 3.42x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | 30.9K | $253.1K | $8.20 | 11.89x |
This provider submits charges 4.3 times higher than what Medicare actually pays.
A markup ratio of 4.3x means for every $100 Medicare pays, this provider initially charges $430. This is higher 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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