Statistical flag only — not an accusation of fraud
This provider's $32.5M in total Medicare payments ranks in the 97th percentile of Clinical Laboratory providers nationally.
Medicare payments to this provider grew 1410% from 2014 to 2023.
81% of their billing comes from a single procedure code (81490 — Test for detecting genes associated with rheumatoid arthritis using immunoassay technique).
This provider has been statistically flagged with a risk score of 68/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 730% in 2021
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 | $176.59 | $28.03 | 6.30x | $148.56 | $681.0K | 24.3K | 59 |
| 2015 | $174.99 | $27.00 | 6.48x | $147.99 | $763.6K | 28.3K | 62 |
| 2016 | $175.21 | $28.16 | 6.22x | $147.05 | $717.6K | 25.5K | 57 |
| 2017 | $172.61 | $27.66 | 6.24x | $144.95 | $616.5K | 22.3K | 58 |
| 2018 | $167.55 | $24.65 | 6.80x | $142.90 | $543.5K | 22.1K | 56 |
| 2019 | $167.74 | $21.83 | 7.68x | $145.91 | $547.2K | 25.1K | 57 |
| 2020 | $157.48 | $19.58 | 8.04x | $137.90 | $671.6K | 34.3K | 71 |
| 2021 | $230.50 | $96.81 | 2.38x | $133.69 | $5.6M | 57.6K | 73 |
| 2022 | $300.99 | $164.66 | 1.83x | $136.33 | $12.2M | 73.8K | 78 |
| 2023 | $251.05 | $113.34 | 2.22x | $137.71 | $10.3M | 90.7K | 79 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 81490 | Test for detecting genes associated with rheumatoid arthritis using immunoassay technique | 29.7K | $24.6M | $829.99 | 1.19x |
| 82306 | Vitamin d-3 level | 32.5K | $1.2M | $35.88 | 9.03x |
| 86235 | Measurement of antibody for assessment of autoimmune disorder, any method | 44.5K | $788.5K | $17.72 | 7.63x |
| 82533 | Cortisol (hormone) measurement, total | 30.9K | $569.1K | $18.43 | 4.39x |
| 82523 | Collagen cross links test, (urine test to evaluate bone health) | 19.4K | $404.0K | $20.81 | 8.75x |
| 84403 | Testosterone (hormone) level, total | 12.2K | $374.7K | $30.68 | 5.65x |
| 82397 | Analysis using chemiluminescent technique (light and chemical )reaction | 19.5K | $302.1K | $15.51 | 11.43x |
| 86147 | Cardiolipin antibody (tissue antibody) measurement | 10.9K | $274.3K | $25.14 | 6.66x |
| 84402 | Testosterone (hormone) level, free | 9.0K | $268.3K | $29.83 | 5.57x |
| 84432 | Thyroglobulin (thyroid related hormone) level | 11.6K | $215.1K | $18.61 | 5.97x |
| 83970 | Parathormone (parathyroid hormone) level | 4.3K | $211.0K | $48.74 | 3.31x |
| 83520 | Measurement of substance using immunoassay technique | 11.7K | $200.6K | $17.09 | 9.74x |
| 86800 | Thyroglobulin (thyroid protein) antibody measurement | 10.0K | $184.8K | $18.45 | 5.65x |
| G0480 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms | 1.9K | $179.5K | $95.30 | 2.05x |
| 84140 | Pregnenolone (reproductive hormone) level | 5.8K | $139.5K | $24.18 | 5.33x |
| 84443 | Blood test, thyroid stimulating hormone (tsh) | 6.7K | $130.8K | $19.59 | 6.40x |
| 80299 | Quantitation of therapeutic drug | 6.7K | $122.3K | $18.37 | 12.81x |
| 86160 | Measurement of complement (immune system proteins), antigen, | 10.0K | $119.0K | $11.86 | 6.98x |
| 83516 | Analysis of substance using immunoassay technique, multiple step method | 9.3K | $105.7K | $11.34 | 14.32x |
| 84270 | Sex hormone binding globulin (protein) level | 4.1K | $105.4K | $25.59 | 6.03x |
This provider submits charges 2.74 times higher than what Medicare actually pays.
A markup ratio of 2.74x means for every $100 Medicare pays, this provider initially charges $274. 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 Clinical Laboratory providers in CA for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Genomic Health, Inc. | Redwood City, CA | $887.6M | ✓ Clear |
| Unilab Corporation | West Hills, CA | $868.8M | ⚠️ Flagged |
| Caredx Inc. | Brisbane, CA | $751.0M | ✓ Clear |
| Laboratory Corporation Of America | San Diego, CA | $592.4M | ⚠️ Flagged |
| Millennium Health, Llc | San Diego, CA | $587.9M | ✓ Clear |
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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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