Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 91.9% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #91 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 $928.0K in total Medicare payments ranks in the 96th percentile of Geriatric Medicine providers nationally.
Medicare payments to this provider grew 113% 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 | 5.0K | $197.2K | $39.08 | 2.22x |
| 99214 | Office visit, established patient, moderate complexity | 4.5K | $177.5K | $39.07 | 2.40x |
| 99215 | Office visit, established patient, high complexity | 4.0K | $157.8K | $39.07 | 3.12x |
| 99232 | Subsequent hospital care, moderate complexity | 3.5K | $138.1K | $39.08 | 2.61x |
| 99233 | Subsequent hospital care, high complexity | 3.0K | $118.3K | $39.08 | 2.44x |
| 93000 | Electrocardiogram, complete | 2.5K | $98.6K | $39.07 | 2.58x |
| 71046 | Chest X-ray, 2 views | 2.0K | $78.9K | $39.07 | 3.04x |
| 80053 | Comprehensive metabolic panel | 1.5K | $59.2K | $39.08 | 2.15x |
| 85025 | Complete blood count with differential | 1.0K | $39.4K | $39.09 | 3.03x |
| 36415 | Venipuncture for blood draw | 505 | $19.7K | $39.06 | 2.64x |
This provider submits charges 2.6 times higher than what Medicare actually pays.
A markup ratio of 2.6x means for every $100 Medicare pays, this provider initially charges $260. 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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