Statistical flag only — not an accusation of fraud
⚠️ This provider averages 692 services per working day — physically unusual for an individual practitioner
Based on 1.7M total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $19.5M in total Medicare payments ranks in the 99th percentile of Hematology-Oncology providers nationally.
Averaging 692 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 3824% from 2014 to 2023.
This provider has been statistically flagged with a risk score of 66/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 458% in 2017
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 |
|---|---|---|---|---|---|---|---|
| 2014 | $157.50 | $69.76 | 2.26x | $87.74 | $85.0K | 1.2K | 7 |
| 2015 | $160.81 | $72.46 | 2.22x | $88.35 | $98.7K | 1.4K | 7 |
| 2016 | $99.58 | $27.70 | 3.59x | $71.88 | $169.6K | 6.1K | 25 |
| 2017 | $89.59 | $19.52 | 4.59x | $70.07 | $946.8K | 48.5K | 34 |
| 2018 | $64.30 | $14.87 | 4.32x | $49.43 | $2.9M | 192.1K | 54 |
| 2019 | $48.28 | $10.75 | 4.49x | $37.53 | $2.7M | 255.4K | 54 |
| 2020 | $46.78 | $10.98 | 4.26x | $35.80 | $2.7M | 247.6K | 51 |
| 2021 | $48.12 | $11.14 | 4.32x | $36.98 | $3.4M | 305.6K | 49 |
| 2022 | $41.77 | $9.18 | 4.55x | $32.59 | $3.1M | 340.3K | 47 |
| 2023 | $47.17 | $10.07 | 4.68x | $37.10 | $3.3M | 331.2K | 51 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J9271 | Injection, pembrolizumab, 1 mg | 122.2K | $5.0M | $41.21 | 3.31x |
| J9299 | Injection, nivolumab, 1 mg | 119.0K | $2.6M | $22.23 | 3.39x |
| J0897 | Injection, denosumab, 1 mg | 102.9K | $1.6M | $15.85 | 3.50x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 11.2K | $895.1K | $79.92 | 2.63x |
| J0881 | Injection, darbepoetin alfa, 1 microgram (non-esrd use) | 280.5K | $755.4K | $2.69 | 7.80x |
| J2505 | Injection, pegfilgrastim, 6 mg | 235 | $731.6K | $3.1K | 5.31x |
| 78815 | Nuclear medicine study from skull base to mid-thigh with ct scan | 629 | $609.3K | $968.72 | 3.73x |
| J1568 | Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg | 15.7K | $491.8K | $31.39 | 5.06x |
| J9264 | Injection, paclitaxel protein-bound particles, 1 mg | 47.7K | $483.0K | $10.13 | 3.90x |
| J9355 | Injection, trastuzumab, excludes biosimilar, 10 mg | 5.7K | $472.0K | $82.38 | 3.39x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 4.3K | $414.3K | $95.84 | 7.16x |
| J9310 | Injection, rituximab, 100 mg | 511 | $342.9K | $671.11 | 3.40x |
| J9035 | Injection, bevacizumab, 10 mg | 5.1K | $318.7K | $62.61 | 3.42x |
| 99215 | Established patient office or other outpatient visit, 40-54 minutes | 3.1K | $318.1K | $102.67 | 2.62x |
| J9041 | Injection, bortezomib (velcade), 0.1 mg | 6.9K | $245.9K | $35.85 | 3.46x |
| J9173 | Injection, durvalumab, 10 mg | 3.8K | $236.8K | $62.05 | 3.40x |
| Q5119 | Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg | 5.7K | $225.4K | $39.61 | 4.90x |
| J1439 | Injection, ferric carboxymaltose, 1 mg | 217.5K | $189.4K | $0.87 | 4.81x |
| J9395 | Injection, fulvestrant, 25 mg | 6.3K | $183.6K | $29.14 | 8.98x |
| J9022 | Injection, atezolizumab, 10 mg | 2.6K | $166.5K | $63.06 | 3.35x |
This provider submits charges 4.42 times higher than what Medicare actually pays.
A markup ratio of 4.42x means for every $100 Medicare pays, this provider initially charges $442. 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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