Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 88.3% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #408 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 $531.5K in total Medicare payments ranks in the 92th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 127% 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 | 2.0K | $116.1K | $57.97 | 1.94x |
| 99214 | Office visit, established patient, moderate complexity | 1.8K | $104.5K | $57.96 | 2.22x |
| 99215 | Office visit, established patient, high complexity | 1.6K | $92.9K | $57.98 | 1.75x |
| 99232 | Subsequent hospital care, moderate complexity | 1.4K | $81.3K | $57.97 | 1.91x |
| 99233 | Subsequent hospital care, high complexity | 1.2K | $69.7K | $57.96 | 2.18x |
| 93000 | Electrocardiogram, complete | 1.0K | $58.1K | $57.94 | 2.15x |
| 71046 | Chest X-ray, 2 views | 801 | $46.4K | $57.98 | 2.01x |
| 80053 | Comprehensive metabolic panel | 601 | $34.8K | $57.96 | 2.01x |
| 85025 | Complete blood count with differential | 401 | $23.2K | $57.91 | 2.49x |
| 36415 | Venipuncture for blood draw | 200 | $11.6K | $58.05 | 1.90x |
This provider submits charges 2.1 times higher than what Medicare actually pays.
A markup ratio of 2.1x means for every $100 Medicare pays, this provider initially charges $210. 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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