Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 89.5% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #252 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 $124.5K in total Medicare payments ranks in the 66th percentile of Internal Medicine providers nationally.
Medicare payments to this provider grew 108% 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 | 460 | $26.9K | $58.55 | 2.33x |
| 99214 | Office visit, established patient, moderate complexity | 414 | $24.2K | $58.56 | 2.05x |
| 99215 | Office visit, established patient, high complexity | 368 | $21.5K | $58.55 | 2.27x |
| 99232 | Subsequent hospital care, moderate complexity | 322 | $18.9K | $58.56 | 2.49x |
| 99233 | Subsequent hospital care, high complexity | 276 | $16.2K | $58.55 | 2.09x |
| 93000 | Electrocardiogram, complete | 230 | $13.5K | $58.56 | 2.49x |
| 71046 | Chest X-ray, 2 views | 184 | $10.8K | $58.55 | 2.43x |
| 80053 | Comprehensive metabolic panel | 138 | $8.1K | $58.56 | 2.09x |
| 85025 | Complete blood count with differential | 92 | $5.4K | $58.55 | 2.45x |
| 36415 | Venipuncture for blood draw | 46 | $2.7K | $58.57 | 2.62x |
This provider submits charges 2.23 times higher than what Medicare actually pays.
A markup ratio of 2.23x means for every $100 Medicare pays, this provider initially charges $223. 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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