Statistical flag only — not an accusation of fraud
⚠️ This provider averages 765 services per working day — physically unusual for an individual practitioner
Based on 1.3M total services over 7 years (250 working days/year). Learn about impossible service volumes →
This provider's $12.4M in total Medicare payments ranks in the 99th percentile of Hematology providers nationally.
Averaging 765 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 994% from 2017 to 2023.
This provider has been statistically flagged with a risk score of 72/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 488% in 2018
Year-over-year payment surges can indicate changes in practice volume, new services, or billing pattern shifts.
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 |
|---|---|---|---|---|---|---|---|
| 2017 | $28.97 | $4.70 | 6.16x | $24.27 | $316.9K | 67.5K | 22 |
| 2018 | $35.48 | $7.11 | 4.99x | $28.37 | $1.9M | 262.0K | 43 |
| 2019 | $41.96 | $9.37 | 4.48x | $32.59 | $2.3M | 250.6K | 51 |
| 2020 | $39.67 | $8.78 | 4.52x | $30.89 | $1.6M | 178.4K | 40 |
| 2021 | $37.01 | $7.36 | 5.03x | $29.65 | $1.3M | 180.4K | 45 |
| 2022 | $38.29 | $7.64 | 5.01x | $30.65 | $1.5M | 191.6K | 49 |
| 2023 | $69.35 | $16.69 | 4.16x | $52.66 | $3.5M | 207.7K | 44 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J9271 | Injection, pembrolizumab, 1 mg | 53.4K | $2.2M | $41.70 | 3.02x |
| J9299 | Injection, nivolumab, 1 mg | 91.3K | $2.0M | $22.11 | 3.19x |
| J0881 | Injection, darbepoetin alfa, 1 microgram (non-esrd use) | 329.2K | $918.1K | $2.79 | 7.53x |
| J1568 | Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg | 25.5K | $796.5K | $31.19 | 6.12x |
| J9144 | Injection, daratumumab, 10 mg and hyaluronidase-fihj | 19.1K | $720.7K | $37.77 | 3.60x |
| J0897 | Injection, denosumab, 1 mg | 40.0K | $654.1K | $16.37 | 3.12x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 5.3K | $506.7K | $95.33 | 2.44x |
| J2505 | Injection, pegfilgrastim, 6 mg | 156 | $471.3K | $3.0K | 5.54x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 3.7K | $445.8K | $121.58 | 5.64x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 6.1K | $402.4K | $65.74 | 2.38x |
| J9355 | Injection, trastuzumab, 10 mg | 4.2K | $346.5K | $82.34 | 3.24x |
| J1439 | Injection, ferric carboxymaltose, 1 mg | 333.0K | $287.3K | $0.86 | 4.63x |
| J9310 | Injection, rituximab, 100 mg | 313 | $220.6K | $704.73 | 3.45x |
| J1437 | Injection, ferric derisomaltose, 10 mg | 11.0K | $186.2K | $16.93 | 4.40x |
| J9312 | Injection, rituximab, 10 mg | 2.4K | $180.6K | $74.62 | 3.40x |
| J9217 | Leuprolide acetate (for depot suspension), 7.5 mg | 893 | $137.5K | $153.97 | 25.39x |
| Q5119 | Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg | 2.7K | $137.2K | $50.62 | 3.83x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | 14.9K | $121.9K | $8.19 | 4.27x |
| 80053 | Blood test, comprehensive group of blood chemicals | 11.0K | $119.1K | $10.83 | 5.73x |
| 96365 | Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less | 1.7K | $97.6K | $58.42 | 5.20x |
This provider submits charges 4.64 times higher than what Medicare actually pays.
A markup ratio of 4.64x means for every $100 Medicare pays, this provider initially charges $464. 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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