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Miguel Gonzalez
Disclaimer: This report is a statistical analysis of publicly available Medicare data.
The anomalies identified herein do not necessarily constitute findings or accusations of fraud.
Statistical deviation from peer benchmarks may have legitimate clinical or business explanations.
All patterns warrant further investigation and independent verification.
Composite Score
58.6
Risk Classification
watchlist
Anomaly Signals
4
Analysis Period
2021–2023
Executive Summary
Miguel Gonzalez (NPI: 1932205804), a Pathology provider in Miami, FL, has been identified as a PRIORITY-tier anomaly risk with a composite score of 77.3/100. This provider appears on the OIG List of Excluded Individuals/Entities (exclusion date: 2022-05-19), and Medicare billing activity was detected during the exclusion period. Zervio.ai detected 9 independent statistical anomalies across 2 categories, with significant estimated overpayments identified across multiple billing categories.
Key Findings
- Medicare billing activity detected during OIG exclusion period
- Provider name or corporate structure matches pharmacy authorized official or parent organization
- Year-over-year billing growth significantly exceeds peer growth rates
- Provider is a central hub in a referral network with multiple flagged connections
BILLING ANOMALY ANALYSIS — Detailed statistical breakdown across 4 independent signals.
Peer comparison data showing deviation from specialty benchmarks. Financial impact assessment
with estimated overpayment calculations. Timeline and trend analysis showing multi-year patterns.
Prescribing analysis with controlled substance review. Industry payment correlation analysis.
Evidence strength assessment with corroboration matrix. Entity resolution findings.
Legal framework mapping to applicable False Claims Act provisions.
FINANCIAL IMPACT ASSESSMENT — Estimated single damages calculation. Treble damage projection
under 31 U.S.C. 3729. Per-claim civil penalty estimates ($13,946 to $27,894 per false claim).
Recovery breakdown by anomaly category.
PEER COMPARISON — Provider vs. specialty median, 90th percentile, and 95th percentile across
payment per service, services per beneficiary, and high-complexity coding ratio.
Data Sources: CMS Medicare Provider Utilization & Payment Data (Part B, 2021–2023),
CMS Part D Prescriber Data (2021–2023), CMS Open Payments (2021–2023),
HHS-OIG LEIE Exclusion List, NPPES NPI Registry. All data is publicly available.