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: 86%
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
10,814
Total Claims
$933K
Drug Cost
725
Beneficiaries
$1,287
Cost/Patient
Risk Score Breakdown 21/100
Score components are additive. Read full methodology
Peer Comparison vs. 110,156 Internal Medicine providers
+86%
Opioid rate vs peers
4.2% vs 2.2% avg
-9%
Cost per patient vs peers
$1,287 vs $1,411 avg
+11%
Brand preference vs peers
11.8% 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 86% indicates prescribing patterns with significant similarity to confirmed fraud cases. 17 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
4.2%
Opioid Rate
451
Opioid Claims
$6,758
Opioid Cost
5.3%
Long-Acting Rate
Brand vs Generic
Brand: 1,268 claims · $720K
Generic: 9,456 claims · $208K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Empagliflozin | 82 | $93K |
| Apixaban | 109 | $82K |
| Insulin Glargine,hum.Rec.Anlog | 85 | $50K |
| Semaglutide | 32 | $42K |
| Rivaroxaban | 39 | $40K |
| Sitagliptin Phosphate | 35 | $35K |
| Sitagliptin Phos/Metformin Hcl | 29 | $35K |
| Linaclotide | 31 | $29K |
| Budesonide/Formoterol Fumarate | 46 | $23K |
| Tirzepatide | 20 | $21K |
| Lipase/Protease/Amylase | 21 | $21K |
| Ticagrelor | 29 | $17K |
| Dapagliflozin Propanediol | 13 | $17K |
| Fluticasone/Vilanterol | 18 | $15K |
| Fluticasone/Umeclidin/Vilanter | 13 | $12K |
Prescribing Profile
Patient Profile
72
Avg Age
42%
Female
1.50
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