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Several different Medicare providers are enrolled at the exact same street address.

Legitimate clinics sometimes share office space. A large number of unrelated providers at one address can also indicate coordinated billing and warrants a closer review.

The same person or company owns or manages several Medicare providers.

Hospital systems and management companies may own many enrollments. This is background information, not a fraud indicator by itself, and should be reviewed with other records.

Many providers list different suite or unit numbers at the same building, making it look like separate offices.

Suite labels can represent separate offices or can make one operation appear as several providers. Check the building and enrollment records.

An owner or managing person matches the federal exclusion list — the HHS Office of Inspector General's list of people and companies banned from billing Medicare and Medicaid.

Someone lands on this list after a fraud conviction, license revocation, or similar action. If an excluded person still owns or runs a billing provider, billing by that provider may be improper. Name matches can be coincidences, so confirm identity before treating this as proven.

This provider's Medicare payments are far higher than typical for its provider type and state.

A large practice may lawfully bill more than its peers. Large differences should be checked against patient counts, services, and other records.

This provider was paid far more per patient than at least 99% of similar providers in its state that year.

Patient needs can raise costs. Payments far above nearly every peer may also indicate upcoding or incorrect patient counts. This rule requires at least 20 patients and 20 peers.