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
1,064
Total Claims
$43K
Drug Cost
324
Beneficiaries
$133
Cost/Patient
Risk Score Breakdown 8/100
Score components are additive. Read full methodology
Peer Comparison vs. 7,404 Physical Medicine and Rehabilitation providers
-54%
Opioid rate vs peers
9.3% vs 20.2% avg
-71%
Cost per patient vs peers
$133 vs $455 avg
-25%
Brand preference vs peers
2.3% vs 3.1% 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 94% indicates prescribing patterns with significant similarity to confirmed fraud cases. 19 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
9.3%
Opioid Rate
99
Opioid Claims
$2,670
Opioid Cost
—
Long-Acting Rate
Brand vs Generic
Brand: 25 claims · $14K
Generic: 1,039 claims · $29K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Milnacipran Hcl | 23 | $14K |
| Gabapentin | 189 | $7,388 |
| Pregabalin | 162 | $4,959 |
| Duloxetine Hcl | 172 | $4,505 |
| Amitriptyline Hcl | 48 | $1,807 |
| Celecoxib | 37 | $1,273 |
| Hydrocodone/Acetaminophen | 54 | $822 |
| Venlafaxine Hcl | 32 | $686 |
| Tizanidine Hcl | 60 | $626 |
| Diclofenac Sodium | 15 | $620 |
| Doxepin Hcl | 14 | $586 |
| Meloxicam | 78 | $484 |
| Nortriptyline Hcl | 23 | $332 |
| Methocarbamol | 19 | $197 |
| Acetaminophen With Codeine | 12 | $126 |
Prescribing Profile
19
Unique Drugs
8.0
Anomaly Score
Patient Profile
71
Avg Age
67%
Female
1.43
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