Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 93.6% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #27 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 $949.0K in total Medicare payments ranks in the 96th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 108% 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 | 4.2K | $205.8K | $49.07 | 2.11x |
| 99214 | Office visit, established patient, moderate complexity | 3.8K | $185.2K | $49.06 | 1.70x |
| 99215 | Office visit, established patient, high complexity | 3.4K | $164.6K | $49.07 | 1.57x |
| 99232 | Subsequent hospital care, moderate complexity | 2.9K | $144.0K | $49.06 | 1.74x |
| 99233 | Subsequent hospital care, high complexity | 2.5K | $123.5K | $49.05 | 2.03x |
| 93000 | Electrocardiogram, complete | 2.1K | $102.9K | $49.07 | 1.76x |
| 71046 | Chest X-ray, 2 views | 1.7K | $82.3K | $49.05 | 1.85x |
| 80053 | Comprehensive metabolic panel | 1.3K | $61.7K | $49.07 | 1.71x |
| 85025 | Complete blood count with differential | 839 | $41.2K | $49.05 | 1.61x |
| 36415 | Venipuncture for blood draw | 419 | $20.6K | $49.11 | 1.98x |
This provider submits charges 1.84 times higher than what Medicare actually pays.
A markup ratio of 1.84x means for every $100 Medicare pays, this provider initially charges $184. This is lower 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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