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
12,925
Total Claims
$1.2M
Drug Cost
624
Beneficiaries
$1,886
Cost/Patient
Risk Score Breakdown 24/100
Score components are additive. Read full methodology
Peer Comparison vs. 110,156 Internal Medicine providers
+104%
Opioid rate vs peers
4.6% vs 2.2% avg
+34%
Cost per patient vs peers
$1,886 vs $1,411 avg
+4%
Brand preference vs peers
11.0% 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 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
4.6%
Opioid Rate
589
Opioid Claims
$11K
Opioid Cost
—
Long-Acting Rate
Brand vs Generic
Brand: 1,414 claims · $969K
Generic: 11,427 claims · $204K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Apixaban | 196 | $154K |
| Semaglutide | 78 | $101K |
| Etanercept | 11 | $83K |
| Fluticasone/Umeclidin/Vilanter | 66 | $61K |
| Dulaglutide | 43 | $60K |
| Insulin Degludec | 28 | $30K |
| Sitagliptin Phosphate | 24 | $27K |
| Umeclidinium Brm/Vilanterol Tr | 27 | $27K |
| Mirabegron | 45 | $24K |
| Fluticasone/Vilanterol | 42 | $22K |
| Insulin Degludec | 12 | $21K |
| Sacubitril/Valsartan | 11 | $21K |
| Tirzepatide | 14 | $20K |
| Budesonide/Glycopyr/Formoterol | 11 | $20K |
| Exenatide Microspheres | 14 | $17K |
Prescribing Profile
Patient Profile
73
Avg Age
55%
Female
1.45
Avg Risk Score
Explore More
Data from CMS Medicare Part D Prescriber Public Use File, 2023. Risk scores are statistical indicators, not allegations.Methodology · About