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
13,003
Total Claims
$1.9M
Drug Cost
594
Beneficiaries
$3,172
Cost/Patient
Risk Score Breakdown 45/100
Score components are additive. Read full methodology
Peer Comparison vs. 110,156 Internal Medicine providers
+609%
Opioid rate vs peers
15.9% vs 2.2% avg
+125%
Cost per patient vs peers
$3,172 vs $1,411 avg
+32%
Brand preference vs peers
14.0% 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 93% indicates prescribing patterns with significant similarity to confirmed fraud cases. 19 out of 20 decision trees flagged this provider.
Opioid prescribing rate is 609% above the average for Internal Medicine 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
15.9%
Opioid Rate
2,063
Opioid Claims
$169K
Opioid Cost
32.0%
Long-Acting Rate
Brand vs Generic
Brand: 1,820 claims · $1.5M
Generic: 11,148 claims · $375K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Lipase/Protease/Amylase | 29 | $171K |
| Apixaban | 161 | $166K |
| Linaclotide | 94 | $115K |
| Dulaglutide | 56 | $88K |
| Icosapent Ethyl | 89 | $84K |
| Semaglutide | 63 | $84K |
| Lipase/Protease/Amylase | 18 | $83K |
| Fluticasone/Umeclidin/Vilanter | 49 | $53K |
| Oxycodone Hcl | 62 | $51K |
| Sitagliptin Phosphate | 38 | $48K |
| Naproxen | 61 | $44K |
| Empagliflozin | 37 | $44K |
| Oxycodone Hcl | 747 | $42K |
| Cyclosporine | 20 | $36K |
| Sacubitril/Valsartan | 25 | $27K |
Prescribing Profile
Patient Profile
71
Avg Age
52%
Female
1.63
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