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
11,978
Total Claims
$1.3M
Drug Cost
1,050
Beneficiaries
$1,234
Cost/Patient
Risk Score Breakdown 15/100
Score components are additive. Read full methodology
Peer Comparison vs. 110,156 Internal Medicine providers
+57%
Opioid rate vs peers
3.5% vs 2.2% avg
-13%
Cost per patient vs peers
$1,234 vs $1,411 avg
+23%
Brand preference vs peers
13.1% vs 10.6% 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.
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
3.5%
Opioid Rate
420
Opioid Claims
$7,483
Opioid Cost
—
Long-Acting Rate
Brand vs Generic
Brand: 1,558 claims · $1.0M
Generic: 10,334 claims · $247K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Apixaban | 147 | $161K |
| Empagliflozin | 113 | $149K |
| Semaglutide | 78 | $111K |
| Dulaglutide | 61 | $85K |
| Fluticasone/Umeclidin/Vilanter | 65 | $56K |
| Insulin Glargine,hum.Rec.Anlog | 63 | $55K |
| Rivaroxaban | 47 | $43K |
| Insulin Degludec | 12 | $40K |
| Dapagliflozin Propanediol | 25 | $20K |
| Tiotropium Bromide | 22 | $20K |
| Fluticasone Propion/Salmeterol | 40 | $19K |
| Insulin Aspart | 19 | $16K |
| Ipratropium/Albuterol Sulfate | 14 | $8,656 |
| Insulin Detemir | 12 | $7,740 |
| Umeclidinium Brm/Vilanterol Tr | 11 | $7,669 |
Prescribing Profile
Patient Profile
74
Avg Age
39%
Female
1.11
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