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: 87%
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
1,796
Total Claims
$136K
Drug Cost
179
Beneficiaries
$760
Cost/Patient
Risk Score Breakdown 8/100
Score components are additive. Read full methodology
Peer Comparison vs. 1,414 Sports Medicine providers
-92%
Opioid rate vs peers
1.2% vs 15.2% avg
+554%
Cost per patient vs peers
$760 vs $116 avg
+719%
Brand preference vs peers
11.0% vs 1.4% 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 87% indicates prescribing patterns with significant similarity to confirmed fraud cases. 17 out of 20 decision trees flagged this provider.
Cost per patient is 554% above the specialty average. Extreme cost outliers may indicate prescribing of unnecessarily expensive brand-name drugs or inappropriate drug utilization.
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
1.2%
Opioid Rate
22
Opioid Claims
$139
Opioid Cost
—
Long-Acting Rate
Brand vs Generic
Brand: 196 claims · $103K
Generic: 1,583 claims · $32K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Semaglutide | 24 | $25K |
| Bempedoic Acid | 12 | $5,066 |
| Atorvastatin Calcium | 86 | $1,511 |
| Verapamil Hcl | 12 | $1,394 |
| Levothyroxine Sodium | 17 | $1,153 |
| Levothyroxine Sodium | 58 | $1,116 |
| Lisinopril | 91 | $911 |
| Sumatriptan Succinate | 23 | $880 |
| Amlodipine Besylate | 76 | $777 |
| Rosuvastatin Calcium | 55 | $684 |
| Tizanidine Hcl | 38 | $667 |
| Duloxetine Hcl | 40 | $652 |
| Losartan Potassium | 27 | $601 |
| Gabapentin | 33 | $558 |
| Metoprolol Succinate | 21 | $434 |
Prescribing Profile
Patient Profile
74
Avg Age
67%
Female
0.91
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