Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 94.7% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #24 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 $846.9K in total Medicare payments ranks in the 95th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 100% 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 | 3.7K | $181.1K | $48.72 | 2.30x |
| 99214 | Office visit, established patient, moderate complexity | 3.3K | $163.0K | $48.72 | 2.20x |
| 99215 | Office visit, established patient, high complexity | 3.0K | $144.9K | $48.71 | 2.13x |
| 99232 | Subsequent hospital care, moderate complexity | 2.6K | $126.8K | $48.72 | 1.81x |
| 99233 | Subsequent hospital care, high complexity | 2.2K | $108.7K | $48.73 | 2.40x |
| 93000 | Electrocardiogram, complete | 1.9K | $90.5K | $48.71 | 2.66x |
| 71046 | Chest X-ray, 2 views | 1.5K | $72.4K | $48.71 | 2.11x |
| 80053 | Comprehensive metabolic panel | 1.1K | $54.3K | $48.72 | 2.23x |
| 85025 | Complete blood count with differential | 743 | $36.2K | $48.75 | 1.80x |
| 36415 | Venipuncture for blood draw | 372 | $18.1K | $48.68 | 2.20x |
This provider submits charges 2.23 times higher than what Medicare actually pays.
A markup ratio of 2.23x means for every $100 Medicare pays, this provider initially charges $223. 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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