Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 92.1% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #101 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 $191.8K in total Medicare payments ranks in the 78th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 126% 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 | 893 | $41.3K | $46.30 | 2.34x |
| 99214 | Office visit, established patient, moderate complexity | 804 | $37.2K | $46.28 | 2.03x |
| 99215 | Office visit, established patient, high complexity | 715 | $33.1K | $46.26 | 2.42x |
| 99232 | Subsequent hospital care, moderate complexity | 625 | $28.9K | $46.31 | 1.86x |
| 99233 | Subsequent hospital care, high complexity | 536 | $24.8K | $46.28 | 2.02x |
| 93000 | Electrocardiogram, complete | 447 | $20.7K | $46.25 | 1.73x |
| 71046 | Chest X-ray, 2 views | 357 | $16.5K | $46.32 | 1.85x |
| 80053 | Comprehensive metabolic panel | 268 | $12.4K | $46.28 | 1.87x |
| 85025 | Complete blood count with differential | 179 | $8.3K | $46.20 | 2.45x |
| 36415 | Venipuncture for blood draw | 89 | $4.1K | $46.46 | 1.74x |
This provider submits charges 2.09 times higher than what Medicare actually pays.
A markup ratio of 2.09x means for every $100 Medicare pays, this provider initially charges $209. 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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