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: 85%
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
496
Total Claims
$12K
Drug Cost
203
Beneficiaries
$60
Cost/Patient
Risk Score Breakdown 8/100
Score components are additive. Read full methodology
Peer Comparison vs. 2,621 Pain Management providers
-49%
Opioid rate vs peers
21.0% vs 41.3% avg
-85%
Cost per patient vs peers
$60 vs $399 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 85% indicates prescribing patterns with significant similarity to confirmed fraud cases. 17 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
21.0%
Opioid Rate
104
Opioid Claims
$1,005
Opioid Cost
—
Long-Acting Rate
This provider's opioid prescribing rate of 21.0% is above the 20% threshold that CMS considers elevated.
Brand vs Generic
Brand: 0 claims · $0
Generic: 489 claims · $6,301
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Gabapentin | 114 | $1,521 |
| Diclofenac Sodium | 33 | $602 |
| Duloxetine Hcl | 35 | $574 |
| Pregabalin | 25 | $509 |
| Oxycodone Hcl | 36 | $443 |
| Hydrocodone/Acetaminophen | 29 | $265 |
| Meloxicam | 33 | $175 |
| Cyclobenzaprine Hcl | 16 | $162 |
| Methocarbamol | 23 | $159 |
| Methylprednisolone | 13 | $130 |
| Baclofen | 13 | $102 |
| Tramadol Hcl | 29 | $90 |
| Diazepam | 33 | $34 |
Prescribing Profile
13
Unique Drugs
8.0
Anomaly Score
Patient Profile
67
Avg Age
70%
Female
1.38
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