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: 92%
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
12,996
Total Claims
$1.2M
Drug Cost
547
Beneficiaries
$2,144
Cost/Patient
Risk Score Breakdown 29/100
Score components are additive. Read full methodology
Peer Comparison vs. 106,889 Family Practice providers
+44%
Opioid rate vs peers
3.7% vs 2.6% avg
+101%
Cost per patient vs peers
$2,144 vs $1,068 avg
+42%
Brand preference vs peers
12.8% 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 92% indicates prescribing patterns with significant similarity to confirmed fraud cases. 18 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
3.7%
Opioid Rate
483
Opioid Claims
$34K
Opioid Cost
19.0%
Long-Acting Rate
Brand vs Generic
Brand: 1,653 claims · $944K
Generic: 11,255 claims · $223K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Interferon Beta-1a/Albumin | 13 | $136K |
| Apixaban | 134 | $88K |
| Empagliflozin | 98 | $79K |
| Rivaroxaban | 85 | $64K |
| Insulin Aspart | 46 | $41K |
| Semaglutide | 29 | $38K |
| Sitagliptin Phosphate | 38 | $31K |
| Sitagliptin Phos/Metformin Hcl | 46 | $30K |
| Fluticasone/Umeclidin/Vilanter | 39 | $29K |
| Insulin Degludec | 32 | $29K |
| Budesonide/Formoterol Fumarate | 49 | $22K |
| Insulin Detemir | 36 | $22K |
| Oxycodone Hcl | 45 | $21K |
| Fluticasone/Vilanterol | 37 | $18K |
| Insulin Glargine,hum.Rec.Anlog | 33 | $17K |
Prescribing Profile
Patient Profile
74
Avg Age
54%
Female
0.95
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