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: 97%
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
1,516
Total Claims
$50K
Drug Cost
396
Beneficiaries
$127
Cost/Patient
Risk Score Breakdown 8/100
Score components are additive. Read full methodology
Peer Comparison vs. 17,619 Orthopedic Surgery providers
-17%
Opioid rate vs peers
25.6% vs 31.0% 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
25.6%
Opioid Rate
388
Opioid Claims
$29K
Opioid Cost
—
Long-Acting Rate
This provider's opioid prescribing rate of 25.6% is above the 20% threshold that CMS considers elevated.
Brand vs Generic
Brand: 25 claims · $32K
Generic: 1,491 claims · $18K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Diclofenac Sodium | 47 | $3,255 |
| Methylprednisolone | 212 | $1,914 |
| Oxycodone Hcl/Acetaminophen | 147 | $1,408 |
| Meloxicam | 279 | $1,356 |
| Hydrocodone/Acetaminophen | 87 | $1,204 |
| Duloxetine Hcl | 45 | $1,089 |
| Lidocaine | 12 | $997 |
| Methocarbamol | 104 | $988 |
| Celecoxib | 51 | $835 |
| Gabapentin | 66 | $754 |
| Tizanidine Hcl | 84 | $616 |
| Cyclobenzaprine Hcl | 67 | $560 |
| Pregabalin | 13 | $369 |
| Ibuprofen | 38 | $360 |
| Tramadol Hcl | 72 | $296 |
Prescribing Profile
20
Unique Drugs
8.0
Anomaly Score
Patient Profile
75
Avg Age
62%
Female
1.22
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