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: 95%
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
13,431
Total Claims
$2.0M
Drug Cost
418
Beneficiaries
$4,698
Cost/Patient
Risk Score Breakdown 43/100
Score components are additive. Read full methodology
Peer Comparison vs. 106,889 Family Practice providers
+488%
Opioid rate vs peers
15.2% vs 2.6% avg
+340%
Cost per patient vs peers
$4,698 vs $1,068 avg
+54%
Brand preference vs peers
13.9% 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
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.
Opioid rate is 488% 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
15.2%
Opioid Rate
2,035
Opioid Claims
$126K
Opioid Cost
18.9%
Long-Acting Rate
Brand vs Generic
Brand: 1,847 claims · $1.6M
Generic: 11,448 claims · $344K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Tirzepatide | 224 | $329K |
| Semaglutide | 150 | $218K |
| Linaclotide | 81 | $114K |
| Apixaban | 87 | $110K |
| Budesonide/Formoterol Fumarate | 132 | $70K |
| Brexpiprazole | 37 | $63K |
| Dulaglutide | 43 | $55K |
| Bictegrav/Emtricit/Tenofov Ala | 12 | $49K |
| Insulin Glargine,hum.Rec.Anlog | 56 | $44K |
| Fluticasone/Umeclidin/Vilanter | 53 | $44K |
| Oxycodone Myristate | 50 | $43K |
| Insulin Glargine,hum.Rec.Anlog | 12 | $31K |
| Sitagliptin Phosphate | 27 | $29K |
| Linagliptin | 15 | $21K |
| Empagliflozin | 11 | $21K |
Prescribing Profile
Patient Profile
67
Avg Age
59%
Female
1.78
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