Risk scores are statistical indicators based on prescribing patterns compared to specialty peers. They are NOT allegations of fraud, misconduct, or improper care. Many legitimate medical reasons can explain outlier prescribing.
Read our methodology →🤖 ML Fraud Detection Score: 88%
Machine learning model identifies prescribing patterns consistent with confirmed fraud cases. This is a statistical indicator, not an accusation.
Risk Flags
Risk indicators are statistical patterns, not allegations. Learn more
9,759
Total Claims
$804K
Drug Cost
304
Beneficiaries
$2,646
Cost/Patient
Risk Score Breakdown 26/100
Score components are additive. Read full methodology
Peer Comparison vs. 110,156 Internal Medicine providers
+81%
Opioid rate vs peers
4.1% vs 2.2% avg
+88%
Cost per patient vs peers
$2,646 vs $1,411 avg
+66%
Brand preference vs peers
17.6% vs 10.6% avg
⚠️ Opioid + Benzodiazepine Co-Prescriber
This provider prescribes both opioids and benzodiazepines. The FDA has issued a Black Box Warning about the life-threatening risks of concurrent use.
🔎 Data Overview
ML fraud detection score of 88% indicates prescribing patterns with significant similarity to confirmed fraud cases. 18 out of 20 decision trees flagged this provider.
This provider co-prescribes opioids and benzodiazepines — a combination carrying an FDA Black Box Warning due to increased risk of respiratory depression and death. While sometimes clinically necessary, this combination requires careful justification.
Insights generated from CMS data analysis. Statistical patterns are not accusations — always consider clinical context.
Opioid Prescribing
4.1%
Opioid Rate
396
Opioid Claims
$7,278
Opioid Cost
5.8%
Long-Acting Rate
Brand vs Generic
Brand: 1,712 claims · $537K
Generic: 7,992 claims · $264K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Collagenase Clostridium Hist. | 33 | $103K |
| Apixaban | 298 | $82K |
| Empagliflozin | 103 | $32K |
| Sevelamer Hcl | 55 | $31K |
| Epoetin Alfa | 35 | $24K |
| Sacubitril/Valsartan | 48 | $20K |
| Rivaroxaban | 47 | $15K |
| Sevelamer Carbonate | 38 | $12K |
| Dapagliflozin Propanediol | 34 | $10K |
| Lipase/Protease/Amylase | 29 | $9,830 |
| Linagliptin | 36 | $9,647 |
| Insulin Glargine,hum.Rec.Anlog | 64 | $9,294 |
| Liraglutide | 16 | $8,714 |
| Fluticasone/Vilanterol | 36 | $8,252 |
| Sodium Zirconium Cyclosilicate | 30 | $7,892 |
Prescribing Profile
Patient Profile
77
Avg Age
48%
Female
3.24
Avg Risk Score
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Data from CMS Medicare Part D Prescriber Public Use File, 2023. Risk scores are statistical indicators, not allegations.Methodology · About