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
9,107
Total Claims
$1.2M
Drug Cost
364
Beneficiaries
$3,285
Cost/Patient
Risk Score Breakdown 33/100
Score components are additive. Read full methodology
Peer Comparison vs. 7,389 General Practice providers
+72%
Opioid rate vs peers
4.2% vs 2.5% avg
+191%
Cost per patient vs peers
$3,285 vs $1,128 avg
+83%
Brand preference vs peers
15.4% vs 8.4% 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.
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
4.2%
Opioid Rate
387
Opioid Claims
$12K
Opioid Cost
17.8%
Long-Acting Rate
Brand vs Generic
Brand: 1,387 claims · $946K
Generic: 7,606 claims · $218K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Etanercept | 24 | $176K |
| Apixaban | 251 | $143K |
| Dulaglutide | 138 | $127K |
| Empagliflozin | 71 | $55K |
| Tirzepatide | 28 | $39K |
| Insulin Glargine,hum.Rec.Anlog | 53 | $35K |
| Semaglutide | 28 | $28K |
| Fluticasone/Umeclidin/Vilanter | 28 | $27K |
| Insulin Pump Cart,automated,bt | 39 | $24K |
| Rivaroxaban | 23 | $17K |
| Insulin Aspart | 13 | $17K |
| Ipratropium/Albuterol Sulfate | 15 | $16K |
| Budesonide/Formoterol Fumarate | 34 | $16K |
| Insulin Glargine,hum.Rec.Anlog | 43 | $14K |
| Sacubitril/Valsartan | 14 | $13K |
Prescribing Profile
Patient Profile
73
Avg Age
56%
Female
1.20
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