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: 85%
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
13,797
Total Claims
$1.3M
Drug Cost
982
Beneficiaries
$1,328
Cost/Patient
Risk Score Breakdown 32/100
Score components are additive. Read full methodology
Peer Comparison vs. 110,156 Internal Medicine providers
+557%
Opioid rate vs peers
14.7% vs 2.2% avg
-6%
Cost per patient vs peers
$1,328 vs $1,411 avg
+8%
Brand preference vs peers
11.5% 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 85% indicates prescribing patterns with significant similarity to confirmed fraud cases. 17 out of 20 decision trees flagged this provider.
Opioid prescribing rate is 557% above the average for Internal Medicine providers. While some providers legitimately treat pain-heavy populations, deviations of this magnitude are rare and warrant examination.
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
14.7%
Opioid Rate
2,029
Opioid Claims
$105K
Opioid Cost
14.5%
Long-Acting Rate
Brand vs Generic
Brand: 1,574 claims · $1.0M
Generic: 12,152 claims · $277K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Empagliflozin | 88 | $117K |
| Apixaban | 97 | $96K |
| Dulaglutide | 42 | $54K |
| Semaglutide | 42 | $43K |
| Semaglutide | 24 | $43K |
| Insulin Glargine,hum.Rec.Anlog | 66 | $43K |
| Fluticasone/Umeclidin/Vilanter | 41 | $33K |
| Insulin Glargine,hum.Rec.Anlog | 39 | $32K |
| Hydrocodone/Acetaminophen | 790 | $26K |
| Dapagliflozin Propanediol | 15 | $26K |
| Mirabegron | 37 | $23K |
| Sitagliptin Phosphate | 13 | $21K |
| Rivaroxaban | 12 | $21K |
| Buprenorphine Hcl | 21 | $20K |
| Tiotropium Bromide | 29 | $19K |
Prescribing Profile
Patient Profile
74
Avg Age
48%
Female
1.32
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