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: 96%
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
390
Total Claims
$8,726
Drug Cost
143
Beneficiaries
$61
Cost/Patient
Risk Score Breakdown 8/100
Score components are additive. Read full methodology
Peer Comparison vs. 109,535 Physician Assistant providers
+157%
Opioid rate vs peers
23.6% vs 9.2% avg
-92%
Cost per patient vs peers
$61 vs $719 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
Our machine learning model — trained on 281 confirmed fraud cases — gives this provider a "Very High" fraud-pattern score. All 20 decision trees in our ensemble model agree that this provider's prescribing patterns resemble those of confirmed fraud cases. This is a statistical finding, not an accusation.
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
23.6%
Opioid Rate
92
Opioid Claims
$756
Opioid Cost
—
Long-Acting Rate
This provider's opioid prescribing rate of 23.6% is above the 20% threshold that CMS considers elevated.
Brand vs Generic
Brand: 0 claims · $0
Generic: 390 claims · $8,726
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Celecoxib | 45 | $3,395 |
| Gabapentin | 105 | $1,855 |
| Pregabalin | 30 | $1,322 |
| Diclofenac Sodium | 29 | $696 |
| Methylprednisolone | 21 | $258 |
| Tramadol Hcl | 45 | $227 |
| Cyclobenzaprine Hcl | 22 | $186 |
| Oxycodone Hcl | 24 | $172 |
| Hydrocodone/Acetaminophen | 15 | $153 |
| Meloxicam | 16 | $49 |
| Diazepam | 11 | $26 |
Prescribing Profile
11
Unique Drugs
8.0
Anomaly Score
Patient Profile
72
Avg Age
55%
Female
1.25
Avg Risk Score
Explore More
Data from CMS Medicare Part D Prescriber Public Use File, 2023. Risk scores are statistical indicators, not allegations.Methodology · About