Statistical flag only — not an accusation of fraud
⚠️ This provider averages 362 services per working day — physically unusual for an individual practitioner
Based on 905.6K total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $16.3M in total Medicare payments ranks in the 99th percentile of Medical Oncology providers nationally.
Their average markup ratio of 6.19x is significantly above the specialty median of 3.6x.
Averaging 362 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 3468% from 2014 to 2023.
This provider has been statistically flagged with a risk score of 79/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 1234% in 2019
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 | $171.37 | $91.36 | 1.88x | $80.01 | $132.8K | 1.5K | 6 |
| 2015 | $164.68 | $89.33 | 1.84x | $75.35 | $155.6K | 1.7K | 6 |
| 2016 | $162.43 | $89.19 | 1.82x | $73.24 | $162.3K | 1.8K | 5 |
| 2017 | $225.26 | $88.28 | 2.55x | $136.98 | $174.3K | 2.0K | 7 |
| 2018 | $239.58 | $83.19 | 2.88x | $156.39 | $167.0K | 2.0K | 5 |
| 2019 | $155.35 | $29.61 | 5.25x | $125.74 | $2.2M | 75.2K | 28 |
| 2020 | $72.48 | $10.62 | 6.82x | $61.86 | $2.4M | 227.2K | 37 |
| 2021 | $108.82 | $16.62 | 6.55x | $92.20 | $3.0M | 179.8K | 36 |
| 2022 | $121.10 | $19.07 | 6.35x | $102.03 | $3.1M | 164.3K | 36 |
| 2023 | $126.11 | $18.95 | 6.65x | $107.16 | $4.7M | 250.2K | 41 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J9271 | Injection, pembrolizumab, 1 mg | 133.0K | $5.6M | $41.73 | 4.95x |
| J9299 | Injection, nivolumab, 1 mg | 125.3K | $2.9M | $22.86 | 5.04x |
| J9144 | Injection, daratumumab, 10 mg and hyaluronidase-fihj | 30.2K | $1.1M | $37.91 | 5.21x |
| J0897 | Injection, denosumab, 1 mg | 60.2K | $1.0M | $17.01 | 4.90x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 11.2K | $997.1K | $88.81 | 4.90x |
| 99215 | Established patient office or other outpatient visit, 40-54 minutes | 3.9K | $523.9K | $134.27 | 5.42x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 4.3K | $500.1K | $116.99 | 8.59x |
| Q5118 | Injection, bevacizumab-bvzr, biosimilar, (zirabev), 10 mg | 15.2K | $493.4K | $32.38 | 5.06x |
| Q5108 | Injection, pegfilgrastim-jmdb, biosimilar, (fulphila), 0.5 mg | 2.0K | $445.2K | $224.83 | 6.09x |
| J9355 | Injection, trastuzumab, 10 mg | 3.9K | $325.9K | $83.78 | 4.60x |
| J9035 | Injection, bevacizumab, 10 mg | 4.9K | $314.3K | $63.68 | 5.02x |
| J2505 | Injection, pegfilgrastim, 6 mg | 78 | $253.5K | $3.3K | 4.50x |
| 99205 | New patient office or other outpatient visit, 60-74 minutes | 1.1K | $183.9K | $167.49 | 4.42x |
| J0881 | Injection, darbepoetin alfa, 1 microgram (non-esrd use) | 68.0K | $177.5K | $2.61 | 7.66x |
| J9312 | Injection, rituximab, 10 mg | 2.1K | $159.2K | $74.34 | 4.72x |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 2.5K | $142.8K | $58.19 | 5.08x |
| J2506 | Injection, pegfilgrastim, excludes biosimilar, 0.5 mg | 1.6K | $137.4K | $86.64 | 18.32x |
| Q5119 | Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg | 5.0K | $132.9K | $26.64 | 8.33x |
| J9217 | Leuprolide acetate (for depot suspension), 7.5 mg | 766 | $109.2K | $142.55 | 27.43x |
| 96417 | Administration of additional new drug or substance into vein, 1 hour or less | 1.6K | $91.3K | $58.79 | 10.55x |
This provider submits charges 6.19 times higher than what Medicare actually pays.
A markup ratio of 6.19x means for every $100 Medicare pays, this provider initially charges $619. 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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