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: 98%
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
10,532
Total Claims
$980K
Drug Cost
600
Beneficiaries
$1,633
Cost/Patient
Risk Score Breakdown 30/100
Score components are additive. Read full methodology
Peer Comparison vs. 110,156 Internal Medicine providers
+305%
Opioid rate vs peers
9.1% vs 2.2% avg
+16%
Cost per patient vs peers
$1,633 vs $1,411 avg
-4%
Brand preference vs peers
10.2% 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
Our machine learning model — trained on 281 confirmed fraud cases — gives this provider a "Very High" fraud-pattern score. All 20 decision trees in our ensemble model agree that this provider's prescribing patterns resemble those of confirmed fraud cases. This is a statistical finding, not an accusation.
Opioid rate is 305% above Internal Medicine 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
9.1%
Opioid Rate
955
Opioid Claims
$98K
Opioid Cost
21.0%
Long-Acting Rate
Brand vs Generic
Brand: 1,064 claims · $704K
Generic: 9,385 claims · $271K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Apixaban | 102 | $115K |
| Oxycodone Hcl | 49 | $71K |
| Sitagliptin Phosphate | 43 | $63K |
| Rivaroxaban | 58 | $52K |
| Dulaglutide | 19 | $35K |
| Semaglutide | 20 | $32K |
| Fluticasone/Vilanterol | 53 | $31K |
| Insulin Glargine,hum.Rec.Anlog | 39 | $25K |
| Empagliflozin | 17 | $21K |
| Tiotropium Bromide | 16 | $16K |
| Fluticasone/Umeclidin/Vilanter | 22 | $15K |
| Budesonide/Formoterol Fumarate | 15 | $11K |
| Oxycodone Hcl | 412 | $10K |
| Insulin Nph Hum/Reg Insulin Hm | 15 | $10K |
| Umeclidinium Brm/Vilanterol Tr | 14 | $9,164 |
Prescribing Profile
Patient Profile
70
Avg Age
54%
Female
1.27
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