Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 89.6% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #352 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 $1.1M in total Medicare payments ranks in the 97th percentile of Family Practice providers nationally.
Medicare payments to this provider grew 107% 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 | 5.2K | $237.6K | $46.13 | 2.13x |
| 99214 | Office visit, established patient, moderate complexity | 4.6K | $213.8K | $46.13 | 2.19x |
| 99215 | Office visit, established patient, high complexity | 4.1K | $190.1K | $46.12 | 2.20x |
| 99395 | Preventive visit, 18-39 years | 3.6K | $166.3K | $46.12 | 1.90x |
| 99396 | Preventive visit, 40-64 years | 3.1K | $142.6K | $46.12 | 1.79x |
| 93000 | Electrocardiogram, complete | 2.6K | $118.8K | $46.14 | 2.07x |
| 71046 | Chest X-ray, 2 views | 2.1K | $95.0K | $46.14 | 1.99x |
| 80053 | Comprehensive metabolic panel | 1.5K | $71.3K | $46.14 | 1.64x |
| 85025 | Complete blood count with differential | 1.0K | $47.5K | $46.14 | 1.92x |
| 36415 | Venipuncture for blood draw | 515 | $23.8K | $46.14 | 1.95x |
This provider submits charges 1.91 times higher than what Medicare actually pays.
A markup ratio of 1.91x means for every $100 Medicare pays, this provider initially charges $191. This is lower 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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