Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 88.6% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #380 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 $122.9K in total Medicare payments ranks in the 58th percentile of Orthopedic Surgery providers nationally.
Medicare payments to this provider grew 118% 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 | 536 | $26.8K | $50.02 | 2.20x |
| 99214 | Office visit, established patient, moderate complexity | 483 | $24.1K | $49.96 | 2.57x |
| 99215 | Office visit, established patient, high complexity | 429 | $21.4K | $50.00 | 1.82x |
| 99232 | Subsequent hospital care, moderate complexity | 375 | $18.8K | $50.05 | 2.46x |
| 99233 | Subsequent hospital care, high complexity | 322 | $16.1K | $49.96 | 2.14x |
| 93000 | Electrocardiogram, complete | 268 | $13.4K | $50.02 | 2.31x |
| 71046 | Chest X-ray, 2 views | 215 | $10.7K | $49.88 | 2.36x |
| 80053 | Comprehensive metabolic panel | 161 | $8.0K | $49.96 | 1.83x |
| 85025 | Complete blood count with differential | 107 | $5.4K | $50.11 | 2.57x |
| 36415 | Venipuncture for blood draw | 54 | $2.7K | $49.65 | 2.23x |
This provider submits charges 2.2 times higher than what Medicare actually pays.
A markup ratio of 2.2x means for every $100 Medicare pays, this provider initially charges $220. 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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