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: 93%
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
13,859
Total Claims
$1.1M
Drug Cost
681
Beneficiaries
$1,671
Cost/Patient
Risk Score Breakdown 24/100
Score components are additive. Read full methodology
Peer Comparison vs. 106,889 Family Practice providers
+141%
Opioid rate vs peers
6.2% vs 2.6% avg
+57%
Cost per patient vs peers
$1,671 vs $1,068 avg
+19%
Brand preference vs peers
10.7% 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 93% indicates prescribing patterns with significant similarity to confirmed fraud cases. 19 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
6.2%
Opioid Rate
860
Opioid Claims
$19K
Opioid Cost
—
Long-Acting Rate
Brand vs Generic
Brand: 1,464 claims · $936K
Generic: 12,232 claims · $188K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Semaglutide | 118 | $129K |
| Empagliflozin | 91 | $75K |
| Insulin Degludec | 59 | $73K |
| Sitagliptin Phosphate | 85 | $65K |
| Tirzepatide | 51 | $56K |
| Linaclotide | 74 | $50K |
| Liraglutide | 29 | $40K |
| Apixaban | 67 | $38K |
| Liraglutide | 42 | $34K |
| Budesonide/Formoterol Fumarate | 71 | $33K |
| Rivaroxaban | 45 | $31K |
| Denosumab | 15 | $25K |
| Insulin Detemir | 31 | $25K |
| Semaglutide | 16 | $21K |
| Tiotropium Bromide | 30 | $18K |
Prescribing Profile
Patient Profile
70
Avg Age
60%
Female
1.29
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