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: 87%
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
8,637
Total Claims
$678K
Drug Cost
545
Beneficiaries
$1,244
Cost/Patient
Risk Score Breakdown 15/100
Score components are additive. Read full methodology
Peer Comparison vs. 106,889 Family Practice providers
+220%
Opioid rate vs peers
8.2% vs 2.6% avg
+17%
Cost per patient vs peers
$1,244 vs $1,068 avg
+20%
Brand preference vs peers
10.8% vs 9.0% 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
ML fraud detection score of 87% indicates prescribing patterns with significant similarity to confirmed fraud cases. 17 out of 20 decision trees flagged this provider.
Opioid rate is 220% above Family Practice peers. This is a significant deviation that may reflect a specialized patient population or concerning prescribing patterns.
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
8.2%
Opioid Rate
712
Opioid Claims
$24K
Opioid Cost
13.5%
Long-Acting Rate
Brand vs Generic
Brand: 926 claims · $520K
Generic: 7,667 claims · $156K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Empagliflozin | 72 | $97K |
| Apixaban | 84 | $83K |
| Rivaroxaban | 49 | $55K |
| Semaglutide | 29 | $32K |
| Sitagliptin Phosphate | 29 | $32K |
| Insulin Lispro | 19 | $23K |
| Dulaglutide | 11 | $21K |
| Semaglutide | 14 | $18K |
| Insulin Glargine,hum.Rec.Anlog | 27 | $13K |
| Atorvastatin Calcium | 787 | $12K |
| Insulin Glargine,hum.Rec.Anlog | 13 | $9,607 |
| Fluticasone Propion/Salmeterol | 13 | $8,707 |
| Hydrocodone/Acetaminophen | 286 | $7,380 |
| Oxycodone Hcl | 15 | $6,662 |
| Levothyroxine Sodium | 303 | $6,244 |
Prescribing Profile
Patient Profile
74
Avg Age
36%
Female
1.12
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