Statistical flag only — not an accusation of fraud
This provider averages 73 services per working day
Based on 181.4K total services over 10 years (250 working days/year). Learn about impossible service volumes →
90.3% wound care billing. 59.1x specialty markup. Skin substitute codes (Q4158 Kerecis, Q4196 PuraPly) dominate. Wound care is DOJ's #1 fraud enforcement target (June 2025 $14.6B takedown). Billing grew 21x in 4 years.
Board-certified plastic surgeon (FACS). Co-founder of Wound Institutes of America. Markets cosmetic surgery but Medicare billing is 90.3% wound care. Billing exploded from $0.7M (2019) to $14.7M (2023).
This provider's $28.9M in total Medicare payments ranks in the 99th percentile of Plastic and Reconstructive Surgery providers nationally.
Their average markup ratio of 9.03x is significantly above the specialty median of 4.1x.
Averaging 73 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 76912% from 2014 to 2023.
This provider has been statistically flagged with a risk score of 92/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 765% in 2015
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 |
|---|---|---|---|---|---|---|---|
| 2014 | $293.17 | $104.46 | 2.81x | $188.71 | $19.1K | 183 | 5 |
| 2015 | $1.2K | $112.12 | 10.52x | $1.1K | $165.4K | 1.5K | 13 |
| 2016 | $832.90 | $65.29 | 12.76x | $767.61 | $553.8K | 8.5K | 18 |
| 2017 | $805.43 | $58.85 | 13.69x | $746.58 | $892.2K | 15.2K | 23 |
| 2018 | $1.5K | $64.71 | 23.32x | $1.4K | $643.9K | 9.9K | 21 |
| 2019 | $3.1K | $64.33 | 47.53x | $3.0K | $662.3K | 10.3K | 21 |
| 2020 | $1.5K | $84.70 | 17.42x | $1.4K | $2.6M | 30.1K | 24 |
| 2021 | $1.1K | $91.45 | 12.41x | $1.0K | $4.1M | 44.8K | 19 |
| 2022 | $1.6K | $174.31 | 9.19x | $1.4K | $4.6M | 26.2K | 20 |
| 2023 | $1.6K | $423.65 | 3.80x | $1.2K | $14.7M | 34.8K | 21 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| Q4158 | Kerecis omega3, per square centimeter | 23.5K | $10.8M | $458.65 | 1.31x |
| Q4196 | Puraply am, per square centimeter | 67.5K | $5.9M | $87.20 | 5.25x |
| Q4205 | Membrane graft or membrane wrap, per square centimeter | 4.2K | $4.9M | $1.2K | 1.28x |
| G0277 | Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval | 11.9K | $1.9M | $161.78 | 13.31x |
| 11043 | Removal of muscle and/or tissue, 20.0 sq cm or less | 5.0K | $709.5K | $143.08 | 63.68x |
| 99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | 7.8K | $703.0K | $90.42 | 18.96x |
| 99308 | Subsequent nursing facility visit, typically 15 minutes per day | 10.5K | $597.3K | $57.07 | 6.25x |
| 99307 | Follow-up nursing facility visit per day, typically 10 minutes | 15.1K | $549.9K | $36.54 | 6.69x |
| 15271 | Application of skin substitute graft to wound of trunk, arms, or legs, 25.0 sq cm or less of wound 100.0 sq cm or less | 4.1K | $427.4K | $103.12 | 60.20x |
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | 5.7K | $352.3K | $62.16 | 19.02x |
| 99183 | Management of oxygen chamber therapy | 3.0K | $272.8K | $90.00 | 14.11x |
| 99305 | Initial nursing facility visit, typically 35 minutes per day | 2.3K | $245.8K | $107.53 | 6.49x |
| 11042 | Removal of skin and tissue, 20.0 sq cm or less | 4.4K | $245.1K | $55.49 | 90.08x |
| 11046 | Removal of muscle and/or tissue, each additional 20.0 sq cm or less | 4.5K | $216.5K | $48.15 | 93.54x |
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | 1.1K | $187.1K | $165.72 | 15.08x |
| 11047 | Removal of bone, each additional 20.0 sq cm or less | 1.7K | $136.2K | $81.18 | 66.05x |
| 11044 | Removal of bone, 20.0 sq cm or less | 699 | $133.0K | $190.27 | 59.44x |
| 99222 | Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes | 1.1K | $120.8K | $111.78 | 17.77x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 1.3K | $88.4K | $67.56 | 9.95x |
| 99304 | Initial nursing facility visit, typically 25 minutes per day | 1.0K | $76.9K | $74.97 | 6.81x |
This provider submits charges 9.03 times higher than what Medicare actually pays.
A markup ratio of 9.03x means for every $100 Medicare pays, this provider initially charges $903. 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 Plastic and Reconstructive Surgery providers in CA for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Johnson Lee, M.D. | Beverly Hills, CA | $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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