Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 90.0% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #236 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 $701.1K in total Medicare payments ranks in the 93th percentile of Infectious Disease providers nationally.
Medicare payments to this provider grew 94% 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 | 2.6K | $151.8K | $58.12 | 2.32x |
| 99214 | Office visit, established patient, moderate complexity | 2.4K | $136.6K | $58.12 | 2.19x |
| 99215 | Office visit, established patient, high complexity | 2.1K | $121.5K | $58.11 | 2.33x |
| 99232 | Subsequent hospital care, moderate complexity | 1.8K | $106.3K | $58.14 | 2.02x |
| 99233 | Subsequent hospital care, high complexity | 1.6K | $91.1K | $58.13 | 2.48x |
| 93000 | Electrocardiogram, complete | 1.3K | $75.9K | $58.12 | 2.84x |
| 71046 | Chest X-ray, 2 views | 1.0K | $60.7K | $58.11 | 2.57x |
| 80053 | Comprehensive metabolic panel | 784 | $45.5K | $58.09 | 2.36x |
| 85025 | Complete blood count with differential | 522 | $30.4K | $58.17 | 2.43x |
| 36415 | Venipuncture for blood draw | 261 | $15.2K | $58.17 | 2.27x |
This provider submits charges 2.46 times higher than what Medicare actually pays.
A markup ratio of 2.46x means for every $100 Medicare pays, this provider initially charges $246. 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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