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
19,131
Total Claims
$2.3M
Drug Cost
574
Beneficiaries
$4,016
Cost/Patient
Risk Score Breakdown 47/100
Score components are additive. Read full methodology
Peer Comparison vs. 110,156 Internal Medicine providers
+700%
Opioid rate vs peers
17.9% vs 2.2% avg
+185%
Cost per patient vs peers
$4,016 vs $1,411 avg
+10%
Brand preference vs peers
11.7% vs 10.6% avg
⚠️ This provider has metrics more than 3 standard deviations above their specialty average in one or more categories.
⚠️ 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 700% 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
17.9%
Opioid Rate
3,425
Opioid Claims
$106K
Opioid Cost
1.7%
Long-Acting Rate
Brand vs Generic
Brand: 2,208 claims · $1.8M
Generic: 16,706 claims · $491K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Fluticasone/Umeclidin/Vilanter | 186 | $205K |
| Dulaglutide | 88 | $178K |
| Budesonide/Formoterol Fumarate | 224 | $174K |
| Semaglutide | 77 | $122K |
| Rivaroxaban | 86 | $109K |
| Sitagliptin Phosphate | 77 | $99K |
| Apixaban | 75 | $92K |
| Oxycodone Hcl/Acetaminophen | 1,738 | $63K |
| Insulin Detemir | 54 | $52K |
| Empagliflozin | 33 | $47K |
| Insulin Detemir | 28 | $38K |
| Albuterol Sulfate | 679 | $37K |
| Hydrocodone/Acetaminophen | 1,276 | $35K |
| Insulin Lispro | 28 | $35K |
| Insulin Glargine,hum.Rec.Anlog | 25 | $34K |
Prescribing Profile
Patient Profile
65
Avg Age
59%
Female
1.59
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