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
15,719
Total Claims
$875K
Drug Cost
500
Beneficiaries
$1,749
Cost/Patient
Risk Score Breakdown 38/100
Score components are additive. Read full methodology
Peer Comparison vs. 106,889 Family Practice providers
+356%
Opioid rate vs peers
11.8% vs 2.6% avg
+64%
Cost per patient vs peers
$1,749 vs $1,068 avg
-21%
Brand preference vs peers
7.1% 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.
Opioid rate is 356% above Family Practice peers. This is a significant deviation that may reflect a specialized patient population or concerning prescribing patterns.
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
11.8%
Opioid Rate
1,850
Opioid Claims
$72K
Opioid Cost
4.4%
Long-Acting Rate
Brand vs Generic
Brand: 1,117 claims · $576K
Generic: 14,528 claims · $295K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Apixaban | 80 | $56K |
| Semaglutide | 50 | $55K |
| Empagliflozin | 62 | $44K |
| Hydrocodone/Acetaminophen | 1,135 | $42K |
| Insulin Glargine,hum.Rec.Anlog | 31 | $33K |
| Insulin Aspart | 24 | $31K |
| Insulin Degludec | 22 | $24K |
| Linaclotide | 33 | $23K |
| Sacubitril/Valsartan | 17 | $19K |
| Umeclidinium Brm/Vilanterol Tr | 25 | $15K |
| Evolocumab | 18 | $13K |
| Insulin Detemir | 18 | $12K |
| Dexlansoprazole | 37 | $12K |
| Sitagliptin Phosphate | 21 | $12K |
| Oxycodone Hcl/Acetaminophen | 211 | $10K |
Prescribing Profile
Patient Profile
69
Avg Age
60%
Female
1.48
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