Statistical flag only — not an accusation of fraud
⚠️ This provider averages 1.8K services per working day — physically unusual for an individual practitioner
Based on 4.5M total services over 10 years (250 working days/year). Learn about impossible service volumes →
This provider's $46.3M in total Medicare payments ranks in the 99th percentile of Medical Oncology providers nationally.
Averaging 1.8K services per working day raises questions about billing patterns.
Medicare payments to this provider grew 53% from 2014 to 2023.
This provider has been statistically flagged with a risk score of 72/100. Statistical flags are not accusations of fraud.
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 78% in 2016
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 | $14.10 | $10.98 | 1.28x | $3.12 | $2.9M | 263.9K | 61 |
| 2015 | $7.91 | $6.16 | 1.28x | $1.75 | $2.2M | 361.9K | 61 |
| 2016 | $23.32 | $9.42 | 2.48x | $13.90 | $4.0M | 420.7K | 62 |
| 2017 | $22.65 | $9.06 | 2.50x | $13.59 | $4.1M | 453.0K | 68 |
| 2018 | $45.30 | $11.14 | 4.07x | $34.16 | $5.4M | 486.7K | 78 |
| 2019 | $41.99 | $10.40 | 4.04x | $31.59 | $6.1M | 585.7K | 90 |
| 2020 | $43.38 | $10.30 | 4.21x | $33.08 | $6.2M | 603.9K | 84 |
| 2021 | $51.99 | $11.66 | 4.46x | $40.33 | $5.9M | 507.7K | 83 |
| 2022 | $50.02 | $11.34 | 4.41x | $38.68 | $5.0M | 440.7K | 81 |
| 2023 | $48.47 | $11.49 | 4.22x | $36.98 | $4.4M | 386.4K | 85 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J9271 | Injection, pembrolizumab, 1 mg | 175.0K | $7.0M | $40.18 | 2.23x |
| J2796 | Injection, romiplostim, 10 micrograms | 65.8K | $3.9M | $58.75 | 2.62x |
| 88185 | Flow cytometry technique for dna or cell analysis, each additional marker | 116.0K | $3.3M | $28.87 | 4.06x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 24.1K | $2.4M | $101.49 | 3.33x |
| J0897 | Injection, denosumab, 1 mg | 149.5K | $2.2M | $14.89 | 4.25x |
| J0885 | Injection, epoetin alfa, (for non-esrd use), 1000 units | 227.0K | $2.2M | $9.61 | 2.75x |
| J9310 | Injection, rituximab, 100 mg | 3.1K | $1.9M | $607.03 | 1.79x |
| J1568 | Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg | 57.7K | $1.8M | $31.63 | 3.26x |
| J2505 | Injection, pegfilgrastim, 6 mg | 592 | $1.8M | $3.0K | 3.24x |
| J9299 | Injection, nivolumab, 1 mg | 73.5K | $1.6M | $21.83 | 2.64x |
| J1439 | Injection, ferric carboxymaltose, 1 mg | 1.4M | $1.2M | $0.86 | 6.10x |
| 99215 | Established patient office or other outpatient visit, 40-54 minutes | 8.6K | $1.2M | $142.84 | 5.16x |
| J9144 | Injection, daratumumab, 10 mg and hyaluronidase-fihj | 31.7K | $1.2M | $36.44 | 3.71x |
| 96413 | Administration of chemotherapy into vein, 1 hour or less | 7.2K | $964.4K | $134.43 | 3.29x |
| J0881 | Injection, darbepoetin alfa, 1 microgram (non-esrd use) | 322.3K | $886.3K | $2.75 | 7.26x |
| J9312 | Injection, rituximab, 10 mg | 9.4K | $691.8K | $73.59 | 4.08x |
| J1569 | Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg | 21.9K | $689.9K | $31.46 | 2.44x |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | 55.5K | $490.4K | $8.83 | 8.07x |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 7.3K | $479.4K | $65.59 | 2.67x |
| 96365 | Infusion into a vein for therapy, prevention, or diagnosis, 1 hour or less | 6.5K | $433.7K | $66.55 | 5.15x |
This provider submits charges 3.6 times higher than what Medicare actually pays.
A markup ratio of 3.6x means for every $100 Medicare pays, this provider initially charges $360. 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 Medical Oncology providers in NY for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Louis Avvento, MD | Southampton, NY | $36.2M | ✓ 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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