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 →Risk Flags
Risk indicators are statistical patterns, not allegations. Learn more
70
Total Claims
$529
Drug Cost
48
Beneficiaries
$11
Cost/Patient
Risk Score Breakdown 35/100
Score components are additive. Read full methodology
Peer Comparison vs. 8,957 Otolaryngology providers
+1021%
Opioid rate vs peers
60.0% vs 5.3% avg
-92%
Cost per patient vs peers
$11 vs $132 avg
⚠️ This provider has metrics more than 3 standard deviations above their specialty average in one or more categories.
🔎 Data Overview
Opioid prescribing rate is 1,021% above the average for Otolaryngology providers. While some providers legitimately treat pain-heavy populations, deviations of this magnitude are rare and warrant examination.
Prescribes only 3 unique drugs with a 60.0% opioid rate. Very low drug diversity combined with high opioid prescribing is a classic statistical marker of potential pill mill operations. However, some legitimate practices (e.g., addiction treatment with buprenorphine) can show similar patterns.
Insights generated from CMS data analysis. Statistical patterns are not accusations — always consider clinical context.
Opioid Prescribing
60.0%
Opioid Rate
42
Opioid Claims
$109
Opioid Cost
—
Long-Acting Rate
This provider's opioid prescribing rate of 60.0% is above the 20% threshold that CMS considers elevated.
Brand vs Generic
Brand: 0 claims · $0
Generic: 69 claims · $513
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Pentoxifylline | 13 | $165 |
| Oxycodone Hcl | 21 | $65 |
| Tramadol Hcl | 19 | $27 |
Prescribing Profile
3
Unique Drugs
35.0
Anomaly Score
Patient Profile
73
Avg Age
42%
Female
1.88
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