Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 90.8% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #176 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 $1.5M in total Medicare payments ranks in the 95th percentile of Pain Management providers nationally.
Medicare payments to this provider grew 109% 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 | 4.7K | $330.0K | $70.69 | 2.34x |
| 99214 | Office visit, established patient, moderate complexity | 4.2K | $297.0K | $70.69 | 2.37x |
| 99215 | Office visit, established patient, high complexity | 3.7K | $264.0K | $70.70 | 2.89x |
| 99232 | Subsequent hospital care, moderate complexity | 3.3K | $231.0K | $70.70 | 2.47x |
| 99233 | Subsequent hospital care, high complexity | 2.8K | $198.0K | $70.68 | 2.23x |
| 93000 | Electrocardiogram, complete | 2.3K | $165.0K | $70.69 | 2.77x |
| 71046 | Chest X-ray, 2 views | 1.9K | $132.0K | $70.70 | 2.55x |
| 80053 | Comprehensive metabolic panel | 1.4K | $99.0K | $70.71 | 3.04x |
| 85025 | Complete blood count with differential | 934 | $66.0K | $70.66 | 3.30x |
| 36415 | Venipuncture for blood draw | 467 | $33.0K | $70.66 | 2.72x |
This provider submits charges 2.77 times higher than what Medicare actually pays.
A markup ratio of 2.77x means for every $100 Medicare pays, this provider initially charges $277. 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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