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: 88%
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
33,150
Total Claims
$2.9M
Drug Cost
1,197
Beneficiaries
$2,426
Cost/Patient
Risk Score Breakdown 49/100
Score components are additive. Read full methodology
Peer Comparison vs. 106,889 Family Practice providers
+857%
Opioid rate vs peers
24.7% vs 2.6% avg
+127%
Cost per patient vs peers
$2,426 vs $1,068 avg
-5%
Brand preference vs peers
8.5% vs 9.0% 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 88% indicates prescribing patterns with significant similarity to confirmed fraud cases. 18 out of 20 decision trees flagged this provider.
Opioid prescribing rate is 857% above the average for Family Practice 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
24.7%
Opioid Rate
8,180
Opioid Claims
$491K
Opioid Cost
23.2%
Long-Acting Rate
This provider's opioid prescribing rate of 24.7% is above the 20% threshold that CMS considers elevated.
Brand vs Generic
Brand: 2,801 claims · $2.0M
Generic: 30,039 claims · $909K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Dulaglutide | 224 | $287K |
| Dapagliflozin Propanediol | 144 | $159K |
| Empagliflozin | 117 | $134K |
| Semaglutide | 111 | $127K |
| Hydrocodone/Acetaminophen | 2,760 | $124K |
| Apixaban | 79 | $108K |
| Oxycodone Hcl/Acetaminophen | 2,298 | $105K |
| Oxycodone Myristate | 130 | $75K |
| Lidocaine | 677 | $69K |
| Linaclotide | 98 | $62K |
| Sitagliptin Phosphate | 41 | $62K |
| Tirzepatide | 53 | $58K |
| Budesonide/Glycopyr/Formoterol | 55 | $56K |
| Budesonide/Formoterol Fumarate | 111 | $55K |
| Lidocaine | 53 | $54K |
Prescribing Profile
Patient Profile
64
Avg Age
56%
Female
1.89
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