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
807
Total Claims
$706K
Drug Cost
49
Beneficiaries
$14K
Cost/Patient
Risk Score Breakdown 14/100
Score components are additive. Read full methodology
Peer Comparison vs. 110,156 Internal Medicine providers
+49%
Opioid rate vs peers
3.3% vs 2.2% avg
+921%
Cost per patient vs peers
$14K vs $1,411 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.
Cost per patient is 921% 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
3.3%
Opioid Rate
27
Opioid Claims
$923
Opioid Cost
—
Long-Acting Rate
Brand vs Generic
Brand: 0 claims · $0
Generic: 545 claims · $15K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Bictegrav/Emtricit/Tenofov Ala | 44 | $183K |
| Dolutegravir Sodium | 76 | $160K |
| Emtricitabine/Tenofov Alafenam | 73 | $158K |
| Elviteg/Cob/Emtri/Tenof Alafen | 33 | $135K |
| Entecavir | 26 | $2,863 |
| Testosterone | 18 | $1,034 |
| Acyclovir | 21 | $771 |
| Buprenorphine Hcl/Naloxone Hcl | 13 | $600 |
| Gabapentin | 23 | $576 |
| Atorvastatin Calcium | 16 | $433 |
| Omeprazole | 17 | $343 |
| Hydrocodone/Acetaminophen | 13 | $326 |
| Ketoconazole | 11 | $271 |
| Loperamide Hcl | 12 | $255 |
| Bupropion Hcl | 16 | $254 |
Prescribing Profile
26
Unique Drugs
14.0
Anomaly Score
Patient Profile
59
Avg Age
25%
Female
1.87
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