Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 88.5% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #377 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 $459.7K in total Medicare payments ranks in the 91th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 112% 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 | 1.6K | $100.4K | $61.91 | 1.94x |
| 99214 | Office visit, established patient, moderate complexity | 1.5K | $90.4K | $61.90 | 1.97x |
| 99215 | Office visit, established patient, high complexity | 1.3K | $80.3K | $61.94 | 2.58x |
| 99232 | Subsequent hospital care, moderate complexity | 1.1K | $70.3K | $61.93 | 1.96x |
| 99233 | Subsequent hospital care, high complexity | 973 | $60.3K | $61.92 | 2.11x |
| 93000 | Electrocardiogram, complete | 811 | $50.2K | $61.91 | 2.63x |
| 71046 | Chest X-ray, 2 views | 649 | $40.2K | $61.89 | 2.47x |
| 80053 | Comprehensive metabolic panel | 487 | $30.1K | $61.86 | 1.94x |
| 85025 | Complete blood count with differential | 324 | $20.1K | $61.99 | 2.44x |
| 36415 | Venipuncture for blood draw | 162 | $10.0K | $61.99 | 2.42x |
This provider submits charges 2.27 times higher than what Medicare actually pays.
A markup ratio of 2.27x means for every $100 Medicare pays, this provider initially charges $227. 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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