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: 92%
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
13,972
Total Claims
$1.4M
Drug Cost
850
Beneficiaries
$1,610
Cost/Patient
Risk Score Breakdown 21/100
Score components are additive. Read full methodology
Peer Comparison vs. 16,767 Hospitalist providers
-12%
Opioid rate vs peers
2.6% vs 3.0% avg
+277%
Cost per patient vs peers
$1,610 vs $427 avg
+133%
Brand preference vs peers
12.2% vs 5.2% 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 92% indicates prescribing patterns with significant similarity to confirmed fraud cases. 18 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
2.6%
Opioid Rate
366
Opioid Claims
$4,166
Opioid Cost
—
Long-Acting Rate
Brand vs Generic
Brand: 1,669 claims · $925K
Generic: 12,022 claims · $428K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Sitagliptin Phosphate | 108 | $98K |
| Metformin Hcl | 28 | $83K |
| Apixaban | 122 | $74K |
| Insulin Glargine,hum.Rec.Anlog | 128 | $55K |
| Dulaglutide | 46 | $52K |
| Semaglutide | 40 | $49K |
| Diclofenac Sodium | 204 | $43K |
| Omeprazole/Sodium Bicarbonate | 24 | $42K |
| Semaglutide | 36 | $37K |
| Rivaroxaban | 40 | $30K |
| Empagliflozin | 31 | $25K |
| Insulin Aspart | 47 | $24K |
| Linaclotide | 20 | $24K |
| Linagliptin | 14 | $21K |
| Sitagliptin Phos/Metformin Hcl | 25 | $19K |
Prescribing Profile
Patient Profile
72
Avg Age
54%
Female
1.38
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