Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 95.5% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #2 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 $1.0M in total Medicare payments ranks in the 96th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 133% from 2014 to 2023.
AI-generated analysis based on Medicare payment data.
Average per-service amounts submitted by the provider compared to what Medicare actually paid — the gap represents the markup.
| Year | Avg Submitted | Avg Paid | Markup Ratio | Gap per Service | Total Payments | Services | Beneficiaries |
|---|---|---|---|---|---|---|---|
| 2014 | $89.11 | $45.14 | 1.97x | $43.97 | $61.0K | 1.4K | 369 |
| 2015 | $89.07 | $45.12 | 1.97x | $43.95 | $71.2K | 1.6K | 431 |
| 2016 | $89.09 | $45.13 | 1.97x | $43.96 | $81.4K | 1.8K | 492 |
| 2017 | $89.11 | $45.14 | 1.97x | $43.97 | $91.5K | 2.0K | 554 |
| 2018 | $89.07 | $45.12 | 1.97x | $43.95 | $101.7K | 2.3K | 616 |
| 2019 | $89.07 | $45.12 | 1.97x | $43.95 | $101.7K | 2.3K | 616 |
| 2020 | $89.09 | $45.13 | 1.97x | $43.96 | $111.9K | 2.5K | 677 |
| 2021 | $89.11 | $45.14 | 1.97x | $43.97 | $122.0K | 2.7K | 739 |
| 2022 | $89.09 | $45.13 | 1.97x | $43.96 | $132.2K | 2.9K | 800 |
| 2023 | $89.09 | $45.13 | 1.97x | $43.96 | $142.4K | 3.2K | 862 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office visit, 30-39 minutes | 5.0K | $223.8K | $45.13 | 1.95x |
| 99213 | Established patient office visit, 20-29 minutes | 4.1K | $183.1K | $45.12 | 2.22x |
| 99215 | Established patient office visit, 40-54 minutes | 3.2K | $142.4K | $45.13 | 1.83x |
| 99232 | Subsequent hospital inpatient care, typically 25 minutes per day | 2.3K | $101.7K | $45.12 | 1.69x |
| 99223 | Initial hospital inpatient care, typically 70 minutes per day | 1.8K | $81.4K | $45.13 | 1.90x |
| 99233 | Subsequent hospital inpatient care, typically 35 minutes per day | 1.6K | $71.2K | $45.12 | 2.05x |
| 99222 | Initial hospital inpatient care, typically 50 minutes per day | 1.4K | $61.0K | $45.14 | 1.75x |
| 99291 | Critical care, first 30-74 minutes | 1.1K | $50.9K | $45.12 | 2.14x |
| G0463 | Hospital outpatient clinic visit | 1.1K | $50.9K | $45.12 | 1.81x |
| 99212 | Established patient office visit, 10-19 minutes | 1.1K | $50.9K | $45.12 | 1.97x |
This provider submits charges 1.97 times higher than what Medicare actually pays.
A markup ratio of 1.97x means for every $100 Medicare pays, this provider initially charges $197. 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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