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
13,238
Total Claims
$973K
Drug Cost
482
Beneficiaries
$2,019
Cost/Patient
Risk Score Breakdown 24/100
Score components are additive. Read full methodology
Peer Comparison vs. 106,889 Family Practice providers
+70%
Opioid rate vs peers
4.4% vs 2.6% avg
+89%
Cost per patient vs peers
$2,019 vs $1,068 avg
-32%
Brand preference vs peers
6.1% 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 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
4.4%
Opioid Rate
581
Opioid Claims
$18K
Opioid Cost
—
Long-Acting Rate
Brand vs Generic
Brand: 806 claims · $636K
Generic: 12,370 claims · $335K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Paliperidone Palmitate | 21 | $75K |
| Cariprazine Hcl | 35 | $52K |
| Dupilumab | 12 | $46K |
| Rivaroxaban | 39 | $45K |
| Insulin Degludec | 16 | $45K |
| Semaglutide | 31 | $44K |
| Apixaban | 47 | $40K |
| Sitagliptin Phosphate | 54 | $40K |
| Insulin Glargine,hum.Rec.Anlog | 34 | $36K |
| Lurasidone Hcl | 49 | $26K |
| Aripiprazole | 239 | $25K |
| Lurasidone Hcl | 14 | $21K |
| Fluticasone/Vilanterol | 39 | $17K |
| Divalproex Sodium | 138 | $13K |
| Quetiapine Fumarate | 473 | $12K |
Prescribing Profile
Patient Profile
63
Avg Age
53%
Female
1.05
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