Statistical flag only — not an accusation of fraud
⚠️ This provider averages 1.4K services per working day — physically unusual for an individual practitioner
Based on 3.5M total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $38.5M in total Medicare payments ranks in the 99th percentile of Hematology-Oncology providers nationally.
Averaging 1.4K services per working day raises questions about billing patterns.
This provider has been statistically flagged with a risk score of 74/100. Statistical flags are not accusations of fraud.
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 | $38.28 | $7.94 | 4.82x | $30.34 | $2.5M | 320.3K | 62 |
| 2015 | $34.79 | $7.03 | 4.95x | $27.76 | $2.8M | 399.7K | 65 |
| 2016 | $44.35 | $9.60 | 4.62x | $34.75 | $3.3M | 340.0K | 61 |
| 2017 | $48.33 | $10.82 | 4.47x | $37.51 | $4.2M | 384.4K | 63 |
| 2018 | $56.93 | $13.19 | 4.32x | $43.74 | $4.3M | 327.2K | 60 |
| 2019 | $55.60 | $12.30 | 4.52x | $43.30 | $5.2M | 425.6K | 66 |
| 2020 | $60.50 | $12.99 | 4.66x | $47.51 | $4.5M | 345.2K | 63 |
| 2021 | $57.39 | $11.99 | 4.79x | $45.40 | $4.1M | 345.5K | 63 |
| 2022 | $70.50 | $13.87 | 5.08x | $56.63 | $4.0M | 290.0K | 57 |
| 2023 | $62.80 | $12.12 | 5.18x | $50.68 | $3.5M | 292.5K | 56 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J9271 | Injection, pembrolizumab, 1 mg | 159.4K | $6.4M | $39.93 | 3.36x |
| J9299 | Injection, nivolumab, 1 mg | 162.2K | $3.6M | $22.18 | 3.35x |
| J9355 | Injection, trastuzumab, excludes biosimilar, 10 mg | 33.7K | $2.5M | $74.84 | 3.42x |
| J2505 | Injection, pegfilgrastim, 6 mg | 736 | $2.3M | $3.1K | 4.97x |
| J0881 | Injection, darbepoetin alfa, 1 microgram (non-esrd use) | 649.1K | $1.9M | $2.89 | 7.05x |
| J0897 | Injection, denosumab, 1 mg | 125.3K | $1.8M | $14.44 | 3.69x |
| J9310 | Injection, rituximab, 100 mg | 2.6K | $1.6M | $623.26 | 3.42x |
| J9041 | Injection, bortezomib, 0.1 mg | 48.8K | $1.5M | $30.47 | 4.06x |
| J9035 | Injection, bevacizumab, 10 mg | 21.1K | $1.2M | $55.68 | 3.37x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 18.6K | $1.0M | $56.35 | 2.96x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 9.6K | $1.0M | $105.54 | 6.70x |
| G9678 | Oncology care model (ocm) monthly enhanced oncology services (meos) payment for ocm enhanced services. g9678 payments may only be made to ocm practitioners for ocm beneficiaries for the furnishment of enhanced services as defined in the ocm participation a | 6.4K | $1.0M | $157.94 | 1.01x |
| J9264 | Injection, paclitaxel protein-bound particles, 1 mg | 106.7K | $924.0K | $8.66 | 3.87x |
| J9395 | Injection, fulvestrant, 25 mg | 16.7K | $885.6K | $53.06 | 4.77x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 10.3K | $869.3K | $84.51 | 2.93x |
| J9312 | Injection, rituximab, 10 mg | 10.0K | $746.6K | $74.44 | 3.41x |
| Q5119 | Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg | 11.2K | $496.1K | $44.49 | 4.36x |
| J9173 | Injection, durvalumab, 10 mg | 7.8K | $480.8K | $61.46 | 3.27x |
| 80053 | Blood test, comprehensive group of blood chemicals | 38.5K | $443.8K | $11.54 | 5.37x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | 45.9K | $409.3K | $8.91 | 3.93x |
This provider submits charges 4.72 times higher than what Medicare actually pays.
A markup ratio of 4.72x means for every $100 Medicare pays, this provider initially charges $472. 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.
Other Hematology-Oncology providers in VA for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Mark Fleming, MD | Hampton, VA | $37.6M | ⚠️ Flagged |
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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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