Statistical flag only — not an accusation of fraud
⚠️ This provider averages 1.1K services per working day — physically unusual for an individual practitioner
Based on 2.7M total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $27.0M in total Medicare payments ranks in the 99th percentile of Hematology-Oncology providers nationally.
Averaging 1.1K services per working day raises questions about billing patterns.
Medicare payments to this provider grew 61% 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 58% in 2021
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 | $26.65 | $9.61 | 2.77x | $17.04 | $1.9M | 197.1K | 65 |
| 2015 | $27.22 | $10.82 | 2.52x | $16.40 | $2.3M | 216.6K | 66 |
| 2016 | $23.57 | $9.00 | 2.62x | $14.57 | $2.0M | 222.1K | 68 |
| 2017 | $27.22 | $10.74 | 2.53x | $16.48 | $3.1M | 289.2K | 74 |
| 2018 | $51.49 | $12.09 | 4.26x | $39.40 | $3.1M | 253.4K | 84 |
| 2019 | $42.85 | $9.25 | 4.63x | $33.60 | $2.5M | 269.6K | 82 |
| 2020 | $49.81 | $9.84 | 5.06x | $39.97 | $2.1M | 215.2K | 81 |
| 2021 | $47.86 | $9.16 | 5.22x | $38.70 | $3.3M | 364.9K | 88 |
| 2022 | $46.02 | $9.27 | 4.96x | $36.75 | $3.6M | 391.0K | 87 |
| 2023 | $51.98 | $11.99 | 4.34x | $39.99 | $3.1M | 254.5K | 87 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J9271 | Injection, pembrolizumab, 1 mg | 73.2K | $3.1M | $41.76 | 2.31x |
| 88185 | Flow cytometry technique for dna or cell analysis, each additional marker | 88.9K | $2.5M | $28.52 | 4.21x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 19.7K | $2.0M | $100.83 | 3.40x |
| J0897 | Injection, denosumab, 1 mg | 105.4K | $1.5M | $14.62 | 4.29x |
| J9310 | Injection, rituximab, 100 mg | 1.9K | $1.2M | $620.72 | 2.23x |
| 78816 | Nuclear medicine study with CT imaging whole body | 869 | $1.1M | $1.3K | 2.24x |
| J2796 | Injection, romiplostim, 10 micrograms | 15.9K | $962.4K | $60.34 | 2.78x |
| J2505 | Injection, pegfilgrastim, 6 mg | 308 | $942.7K | $3.1K | 3.15x |
| J0885 | Injection, epoetin alfa, (for non-esrd use), 1000 units | 90.0K | $881.3K | $9.79 | 3.05x |
| 99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | 7.8K | $727.3K | $93.62 | 3.50x |
| 99215 | Established patient office or other outpatient visit, 40-54 minutes | 4.4K | $640.5K | $146.10 | 5.49x |
| J1439 | Injection, ferric carboxymaltose, 1 mg | 744.8K | $640.5K | $0.86 | 6.50x |
| J9299 | Injection, nivolumab, 1 mg | 28.6K | $602.3K | $21.03 | 2.57x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 4.3K | $583.2K | $134.50 | 3.86x |
| J1568 | Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg | 18.7K | $582.9K | $31.15 | 3.19x |
| 99490 | Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month | 10.4K | $456.9K | $43.83 | 2.83x |
| J0881 | Injection, darbepoetin alfa, 1 microgram (non-esrd use) | 166.5K | $446.3K | $2.68 | 7.45x |
| J1454 | Injection, fosnetupitant 235 mg and palonosetron 0.25 mg | 956 | $383.5K | $401.17 | 4.71x |
| 99205 | New patient office or other outpatient visit, 60-74 minutes | 1.7K | $316.7K | $191.51 | 3.29x |
| 82728 | Ferritin (blood protein) level | 20.1K | $302.9K | $15.08 | 8.49x |
This provider submits charges 4 times higher than what Medicare actually pays.
A markup ratio of 4x means for every $100 Medicare pays, this provider initially charges $400. 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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