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: 94%
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
578
Total Claims
$11K
Drug Cost
83
Beneficiaries
$137
Cost/Patient
Risk Score Breakdown 35/100
Score components are additive. Read full methodology
Peer Comparison vs. 218,535 Nurse Practitioner providers
+920%
Opioid rate vs peers
38.6% vs 3.8% avg
-88%
Cost per patient vs peers
$137 vs $1,174 avg
-75%
Brand preference vs peers
2.2% vs 8.9% avg
⚠️ This provider has metrics more than 3 standard deviations above their specialty average in one or more categories.
⚠️ 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 94% indicates prescribing patterns with significant similarity to confirmed fraud cases. 19 out of 20 decision trees flagged this provider.
Opioid prescribing rate is 920% above the average for Nurse Practitioner providers. While some providers legitimately treat pain-heavy populations, deviations of this magnitude are rare and warrant examination.
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
38.6%
Opioid Rate
223
Opioid Claims
$4,460
Opioid Cost
13.9%
Long-Acting Rate
This provider's opioid prescribing rate of 38.6% is above the 20% threshold that CMS considers elevated.
Brand vs Generic
Brand: 13 claims · $527
Generic: 565 claims · $11K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Hydrocodone/Acetaminophen | 155 | $3,020 |
| Diclofenac Sodium | 28 | $1,080 |
| Gabapentin | 31 | $686 |
| Morphine Sulfate | 13 | $460 |
| Cephalexin | 38 | $286 |
| Alprazolam | 15 | $240 |
| Nystatin | 12 | $202 |
| Trazodone Hcl | 31 | $182 |
| Mirtazapine | 11 | $158 |
| Methadone Hcl | 19 | $147 |
| Furosemide | 16 | $144 |
| Lorazepam | 13 | $125 |
| Doxycycline Monohydrate | 11 | $118 |
| Doxepin Hcl | 11 | $94 |
| Tramadol Hcl | 16 | $83 |
Prescribing Profile
16
Unique Drugs
35.0
Anomaly Score
Patient Profile
82
Avg Age
68%
Female
2.54
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