Statistical flag only — not an accusation of fraud
This provider's $2.0M in total Medicare payments ranks in the 92th percentile of Hematology-Oncology providers nationally.
Their average markup ratio of 19.93x is significantly above the specialty median of 3.5x.
Medicare payments to this provider grew 77% 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.
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 | $360.14 | $18.07 | 19.93x | $342.07 | $142.9K | 7.9K | 378 |
| 2015 | $360.14 | $18.07 | 19.93x | $342.07 | $155.1K | 8.6K | 410 |
| 2016 | $360.14 | $18.07 | 19.93x | $342.07 | $167.4K | 9.3K | 442 |
| 2017 | $360.14 | $18.07 | 19.93x | $342.07 | $179.6K | 9.9K | 475 |
| 2018 | $360.14 | $18.07 | 19.93x | $342.07 | $191.9K | 10.6K | 507 |
| 2019 | $360.14 | $18.07 | 19.93x | $342.07 | $204.1K | 11.3K | 539 |
| 2020 | $360.14 | $18.07 | 19.93x | $342.07 | $216.4K | 12.0K | 572 |
| 2021 | $360.14 | $18.07 | 19.93x | $342.07 | $228.6K | 12.7K | 604 |
| 2022 | $360.14 | $18.07 | 19.93x | $342.07 | $240.9K | 13.3K | 636 |
| 2023 | $360.14 | $18.07 | 19.93x | $342.07 | $253.1K | 14.0K | 669 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99213 | Office/outpatient visit, est patient, low | 38.6K | $696.9K | $18.07 | 22.33x |
| 99214 | Office/outpatient visit, est patient, moderate | 19.3K | $348.4K | $18.07 | 23.52x |
| 99215 | Office/outpatient visit, est patient, high | 12.9K | $232.3K | $18.07 | 21.48x |
| 99223 | Initial hospital care, high complexity | 9.6K | $174.2K | $18.07 | 21.36x |
| 99232 | Subsequent hospital care, moderate | 7.7K | $139.4K | $18.07 | 17.10x |
| 93000 | Electrocardiogram, complete | 6.4K | $116.1K | $18.07 | 20.13x |
| 71046 | Chest X-ray, 2 views | 5.5K | $99.6K | $18.07 | 21.15x |
| 80053 | Comprehensive metabolic panel | 4.8K | $87.1K | $18.07 | 22.59x |
| 85025 | Complete blood count (CBC) | 4.3K | $77.4K | $18.07 | 19.63x |
| 36415 | Venipuncture | 3.9K | $69.7K | $18.07 | 16.37x |
This provider submits charges 19.93 times higher than what Medicare actually pays.
A markup ratio of 19.93x means for every $100 Medicare pays, this provider initially charges $1993. 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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