Our machine learning model analyzed billing patterns, service volumes, markup ratios, and peer comparisons to estimate a 90.9% probability that this provider's billing patterns are consistent with known fraud cases. This is ranked #234 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 $2.0M in total Medicare payments ranks in the 97th percentile of Orthopedic Surgery providers nationally.
Medicare payments to this provider grew 123% 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 | 7.3K | $444.2K | $60.80 | 2.82x |
| 99214 | Office visit, established patient, moderate complexity | 6.6K | $399.7K | $60.81 | 2.65x |
| 99215 | Office visit, established patient, high complexity | 5.8K | $355.3K | $60.80 | 2.80x |
| 99232 | Subsequent hospital care, moderate complexity | 5.1K | $310.9K | $60.81 | 2.85x |
| 99233 | Subsequent hospital care, high complexity | 4.4K | $266.5K | $60.80 | 2.83x |
| 93000 | Electrocardiogram, complete | 3.7K | $222.1K | $60.81 | 2.94x |
| 71046 | Chest X-ray, 2 views | 2.9K | $177.7K | $60.80 | 3.09x |
| 80053 | Comprehensive metabolic panel | 2.2K | $133.2K | $60.82 | 2.32x |
| 85025 | Complete blood count with differential | 1.5K | $88.8K | $60.80 | 2.92x |
| 36415 | Venipuncture for blood draw | 730 | $44.4K | $60.84 | 2.82x |
This provider submits charges 2.77 times higher than what Medicare actually pays.
A markup ratio of 2.77x means for every $100 Medicare pays, this provider initially charges $277. 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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