Statistical flag only — not an accusation of fraud
This provider's $44.2M in total Medicare payments ranks in the 99th percentile of Pharmacy providers nationally.
This provider has been statistically flagged with a risk score of 80/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
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 | $811.85 | $527.89 | 1.54x | $283.96 | $6.5M | 12.4K | 4 |
| 2015 | $549.60 | $168.48 | 3.26x | $381.12 | $3.9M | 23.4K | 6 |
| 2016 | $361.30 | $78.62 | 4.60x | $282.68 | $3.4M | 43.6K | 5 |
| 2017 | $238.91 | $48.43 | 4.93x | $190.48 | $3.1M | 64.4K | 4 |
| 2018 | $210.32 | $41.93 | 5.02x | $168.39 | $3.4M | 80.1K | 4 |
| 2019 | $189.92 | $35.82 | 5.30x | $154.10 | $4.2M | 118.5K | 6 |
| 2020 | $190.88 | $36.29 | 5.26x | $154.59 | $4.9M | 136.2K | 6 |
| 2021 | $201.91 | $40.09 | 5.04x | $161.82 | $5.4M | 134.7K | 7 |
| 2022 | $199.66 | $37.97 | 5.26x | $161.69 | $4.8M | 127.3K | 6 |
| 2023 | $236.29 | $41.33 | 5.72x | $194.96 | $4.4M | 106.0K | 7 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J7999 | Compounded drug, not otherwise classified | 94.6K | $17.3M | $183.18 | 5.98x |
| J0475 | Injection, baclofen, 10 mg | 77.6K | $11.1M | $143.58 | 5.13x |
| J7799 | Noc drugs, other than inhalation drugs, administered through dme | 7.8K | $7.7M | $980.97 | 1.52x |
| J2278 | Injection, ziconotide, 1 microgram | 469.9K | $3.2M | $6.87 | 3.67x |
| A4220 | Refill kit for implantable infusion pump | 64.2K | $3.1M | $48.09 | 1.86x |
| Q9977 | Compounded Drug, Not Otherwise Classified | 3.8K | $956.9K | $254.50 | 4.99x |
| J2274 | Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg | 65.5K | $601.0K | $9.18 | 3.13x |
| J1170 | Injection, hydromorphone, up to 4 mg | 62.2K | $158.1K | $2.54 | 2.39x |
| J3490 | Unclassified drugs | 102 | $6.7K | $65.38 | 4.57x |
| J3010 | Injection, fentanyl citrate, 0.1 mg | 707 | $531.14 | $0.75 | 15.38x |
This provider submits charges 4.46 times higher than what Medicare actually pays.
A markup ratio of 4.46x means for every $100 Medicare pays, this provider initially charges $446. 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.
Other Pharmacy providers in PA for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Accredo Health Group Inc | Warrendale, PA | $208.7M | ✓ Clear |
| Procare Pharmacy Direct, Llc. | Monroeville, PA | $37.2M | ✓ Clear |
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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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