Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 95.7% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #4 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 $601.8K in total Medicare payments ranks in the 94th percentile of Endocrinology providers nationally.
Medicare payments to this provider grew 133% from 2014 to 2023.
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 | $92.44 | $43.40 | 2.13x | $49.04 | $36.1K | 832 | 254 |
| 2015 | $92.42 | $43.39 | 2.13x | $49.03 | $42.1K | 971 | 296 |
| 2016 | $92.40 | $43.38 | 2.13x | $49.02 | $48.1K | 1.1K | 338 |
| 2017 | $92.44 | $43.40 | 2.13x | $49.04 | $54.2K | 1.2K | 380 |
| 2018 | $92.42 | $43.39 | 2.13x | $49.03 | $60.2K | 1.4K | 423 |
| 2019 | $92.42 | $43.39 | 2.13x | $49.03 | $60.2K | 1.4K | 423 |
| 2020 | $92.40 | $43.38 | 2.13x | $49.02 | $66.2K | 1.5K | 465 |
| 2021 | $92.40 | $43.38 | 2.13x | $49.02 | $72.2K | 1.7K | 507 |
| 2022 | $92.42 | $43.39 | 2.13x | $49.03 | $78.2K | 1.8K | 550 |
| 2023 | $92.42 | $43.39 | 2.13x | $49.03 | $84.3K | 1.9K | 592 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| 99214 | Established patient office visit, 30-39 minutes | 3.1K | $132.4K | $43.38 | 2.37x |
| 99213 | Established patient office visit, 20-29 minutes | 2.5K | $108.3K | $43.38 | 2.13x |
| 99215 | Established patient office visit, 40-54 minutes | 1.9K | $84.3K | $43.39 | 2.36x |
| 83036 | Hemoglobin A1c level | 1.4K | $60.2K | $43.39 | 2.00x |
| 80053 | Comprehensive metabolic panel | 1.1K | $48.1K | $43.38 | 2.35x |
| 84443 | Thyroid stimulating hormone (TSH) | 971 | $42.1K | $43.39 | 2.36x |
| 82728 | Ferritin blood test | 832 | $36.1K | $43.40 | 2.16x |
| 80061 | Lipid panel | 694 | $30.1K | $43.36 | 2.06x |
| 36415 | Collection of venous blood by venipuncture | 694 | $30.1K | $43.36 | 2.40x |
| 99211 | Established patient office visit, minimal | 694 | $30.1K | $43.36 | 2.04x |
This provider submits charges 2.3 times higher than what Medicare actually pays.
A markup ratio of 2.3x means for every $100 Medicare pays, this provider initially charges $230. 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.
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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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