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: 90%
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
7,312
Total Claims
$1.1M
Drug Cost
351
Beneficiaries
$3,191
Cost/Patient
Risk Score Breakdown 29/100
Score components are additive. Read full methodology
Peer Comparison vs. 2,621 Pain Management providers
+43%
Opioid rate vs peers
59.0% vs 41.3% avg
+700%
Cost per patient vs peers
$3,191 vs $399 avg
+199%
Brand preference vs peers
11.2% vs 3.8% 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 90% indicates prescribing patterns with significant similarity to confirmed fraud cases. 18 out of 20 decision trees flagged this provider.
Cost per patient is 700% 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
59.0%
Opioid Rate
4,312
Opioid Claims
$812K
Opioid Cost
40.7%
Long-Acting Rate
This provider's opioid prescribing rate of 59.0% is above the 20% threshold that CMS considers elevated.
Brand vs Generic
Brand: 821 claims · $784K
Generic: 6,491 claims · $335K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Oxycodone Hcl | 282 | $368K |
| Oxycodone Myristate | 107 | $108K |
| Methylnaltrexone Bromide | 31 | $103K |
| Oxycodone Hcl/Acetaminophen | 14 | $74K |
| Naloxegol Oxalate | 93 | $49K |
| Oxycodone Hcl | 1,250 | $44K |
| Lidocaine | 25 | $36K |
| Morphine Sulfate | 831 | $30K |
| Oxycodone Hcl/Acetaminophen | 650 | $28K |
| Fentanyl | 182 | $25K |
| Buprenorphine Hcl | 31 | $25K |
| Oxymorphone Hcl | 15 | $22K |
| Tapentadol Hcl | 11 | $16K |
| Gabapentin | 515 | $13K |
| Hydromorphone Hcl | 13 | $9,197 |
Prescribing Profile
48
Unique Drugs
29.0
Anomaly Score
Patient Profile
64
Avg Age
55%
Female
1.96
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