Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 91.1% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #154 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 $210.3K in total Medicare payments ranks in the 80th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 113% 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 | 906 | $45.4K | $50.11 | 2.59x |
| 99214 | Office visit, established patient, moderate complexity | 816 | $40.9K | $50.08 | 1.84x |
| 99215 | Office visit, established patient, high complexity | 725 | $36.3K | $50.10 | 1.83x |
| 99232 | Subsequent hospital care, moderate complexity | 634 | $31.8K | $50.13 | 2.13x |
| 99233 | Subsequent hospital care, high complexity | 544 | $27.2K | $50.08 | 2.24x |
| 93000 | Electrocardiogram, complete | 453 | $22.7K | $50.11 | 1.98x |
| 71046 | Chest X-ray, 2 views | 363 | $18.2K | $50.03 | 2.41x |
| 80053 | Comprehensive metabolic panel | 272 | $13.6K | $50.08 | 1.90x |
| 85025 | Complete blood count with differential | 181 | $9.1K | $50.17 | 2.33x |
| 36415 | Venipuncture for blood draw | 91 | $4.5K | $49.89 | 2.19x |
This provider submits charges 2.22 times higher than what Medicare actually pays.
A markup ratio of 2.22x means for every $100 Medicare pays, this provider initially charges $222. 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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