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
15,885
Total Claims
$6.2M
Drug Cost
340
Beneficiaries
$18K
Cost/Patient
Risk Score Breakdown 38/100
Score components are additive. Read full methodology
Peer Comparison vs. 110,156 Internal Medicine providers
+10%
Opioid rate vs peers
2.5% vs 2.2% avg
+1198%
Cost per patient vs peers
$18K vs $1,411 avg
+92%
Brand preference vs peers
20.4% 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
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.
Cost per patient is 1198% above the specialty average. Extreme cost outliers may indicate prescribing of unnecessarily expensive brand-name drugs or inappropriate drug utilization.
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
2.5%
Opioid Rate
390
Opioid Claims
$6,542
Opioid Cost
—
Long-Acting Rate
Brand vs Generic
Brand: 3,164 claims · $5.9M
Generic: 12,309 claims · $307K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Bictegrav/Emtricit/Tenofov Ala | 431 | $1.7M |
| Darunavir/Cob/Emtri/Tenof Alaf | 126 | $606K |
| Abacavir/Dolutegravir/Lamivudi | 152 | $591K |
| Dolutegravir/Rilpivirine | 99 | $349K |
| Dolutegravir Sodium/Lamivudine | 84 | $258K |
| Cabotegravir/Rilpivirine | 34 | $236K |
| Elviteg/Cob/Emtri/Tenof Alafen | 58 | $230K |
| Darunavir/Cobicistat | 113 | $230K |
| Dolutegravir Sodium | 99 | $125K |
| Emtricitab/Rilpiviri/Tenof Ala | 32 | $120K |
| Valbenazine Tosylate | 24 | $114K |
| Sitagliptin Phos/Metformin Hcl | 122 | $73K |
| Fluticasone/Umeclidin/Vilanter | 83 | $70K |
| Dulaglutide | 68 | $68K |
| Emtricitabine/Tenofov Alafenam | 28 | $65K |
Prescribing Profile
Patient Profile
68
Avg Age
41%
Female
2.01
Avg Risk Score
Explore More
Data from CMS Medicare Part D Prescriber Public Use File, 2023. Risk scores are statistical indicators, not allegations.Methodology · About