Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 90.3% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #141 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 $964.1K in total Medicare payments ranks in the 96th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 128% 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 | 3.9K | $210.4K | $54.52 | 2.13x |
| 99214 | Office visit, established patient, moderate complexity | 3.5K | $189.3K | $54.52 | 2.21x |
| 99215 | Office visit, established patient, high complexity | 3.1K | $168.3K | $54.52 | 2.99x |
| 99232 | Subsequent hospital care, moderate complexity | 2.7K | $147.3K | $54.52 | 2.57x |
| 99233 | Subsequent hospital care, high complexity | 2.3K | $126.2K | $54.52 | 2.74x |
| 93000 | Electrocardiogram, complete | 1.9K | $105.2K | $54.53 | 2.82x |
| 71046 | Chest X-ray, 2 views | 1.5K | $84.2K | $54.50 | 2.85x |
| 80053 | Comprehensive metabolic panel | 1.2K | $63.1K | $54.50 | 2.72x |
| 85025 | Complete blood count with differential | 772 | $42.1K | $54.50 | 3.07x |
| 36415 | Venipuncture for blood draw | 386 | $21.0K | $54.50 | 2.67x |
This provider submits charges 2.6 times higher than what Medicare actually pays.
A markup ratio of 2.6x means for every $100 Medicare pays, this provider initially charges $260. 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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