Statistical flag only — not an accusation of fraud
⚠️ This provider averages 283 services per working day — physically unusual for an individual practitioner
Based on 424.2K total services over 6 years (250 working days/year). Learn about impossible service volumes →
This provider's $10.2M in total Medicare payments ranks in the 99th percentile of Nurse Practitioner providers nationally.
Averaging 283 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 413660% from 2018 to 2023.
This provider has been statistically flagged with a risk score of 67/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 9927% in 2019
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 |
|---|---|---|---|---|---|---|---|
| 2018 | $1.4K | $63.54 | 22.05x | $1.3K | $889.52 | 14 | 1 |
| 2019 | $73.44 | $18.84 | 3.90x | $54.60 | $89.2K | 4.7K | 6 |
| 2020 | $119.32 | $28.48 | 4.19x | $90.84 | $1.4M | 50.4K | 14 |
| 2021 | $142.93 | $32.63 | 4.38x | $110.30 | $2.3M | 71.5K | 14 |
| 2022 | $109.69 | $24.69 | 4.44x | $85.00 | $2.7M | 109.2K | 17 |
| 2023 | $94.28 | $19.54 | 4.82x | $74.74 | $3.7M | 188.3K | 19 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J3245 | Injection, tildrakizumab, 1 mg | 20.0K | $2.2M | $108.66 | 4.27x |
| J0897 | Injection, denosumab, 1 mg | 105.7K | $1.8M | $16.87 | 5.09x |
| J2182 | Injection, mepolizumab, 1 mg | 57.4K | $1.3M | $22.97 | 3.33x |
| J9312 | Injection, rituximab, 10 mg | 15.7K | $1.1M | $69.38 | 3.24x |
| J2357 | Injection, omalizumab, 5 mg | 31.2K | $935.9K | $29.95 | 3.19x |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 27.1K | $883.9K | $32.58 | 8.61x |
| J3380 | Injection, vedolizumab, 1 mg | 50.4K | $874.6K | $17.35 | 4.58x |
| J3111 | Injection, romosozumab-aqqg, 1 mg | 51.2K | $397.5K | $7.76 | 4.00x |
| J1306 | Injection, inclisiran, 1 mg | 28.1K | $264.9K | $9.42 | 6.06x |
| J0129 | Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered) | 5.1K | $172.6K | $33.68 | 3.87x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 1.1K | $96.7K | $84.27 | 2.75x |
| 96365 | Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less | 1.8K | $73.6K | $41.95 | 4.89x |
| J3590 | Unclassified biologics | 18 | $50.8K | $2.8K | 3.56x |
| 96372 | Injection of drug or substance under skin or into muscle | 3.5K | $32.2K | $9.07 | 5.71x |
| 96366 | Infusion into a vein for therapy, prevention, or diagnosis, each additional hour | 2.0K | $27.1K | $13.50 | 4.44x |
| 96415 | Administration of chemotherapy into vein, each additional hour | 1.2K | $21.7K | $18.31 | 4.37x |
| J1439 | Injection, ferric carboxymaltose, 1 mg | 19.5K | $16.1K | $0.83 | 12.99x |
| 96375 | Injection of additional new drug or substance into vein | 1.1K | $11.0K | $10.09 | 5.02x |
| 96401 | Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle | 92 | $4.4K | $48.04 | 2.60x |
| J2930 | Injection, methylprednisolone sodium succinate, up to 125 mg | 751 | $3.3K | $4.34 | 9.27x |
This provider submits charges 4.53 times higher than what Medicare actually pays.
A markup ratio of 4.53x means for every $100 Medicare pays, this provider initially charges $453. 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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