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: 89%
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
5,414
Total Claims
$422K
Drug Cost
338
Beneficiaries
$1,247
Cost/Patient
Risk Score Breakdown 26/100
Score components are additive. Read full methodology
Peer Comparison vs. 2,621 Pain Management providers
+65%
Opioid rate vs peers
68.2% vs 41.3% avg
+213%
Cost per patient vs peers
$1,247 vs $399 avg
+127%
Brand preference vs peers
8.5% vs 3.8% 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 89% 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
68.2%
Opioid Rate
3,694
Opioid Claims
$349K
Opioid Cost
28.8%
Long-Acting Rate
This provider's opioid prescribing rate of 68.2% is above the 20% threshold that CMS considers elevated.
Brand vs Generic
Brand: 462 claims · $195K
Generic: 4,952 claims · $227K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Buprenorphine | 203 | $70K |
| Oxycodone Myristate | 66 | $69K |
| Oxycodone Hcl | 47 | $48K |
| Oxycodone Hcl | 1,102 | $40K |
| Hydrocodone/Acetaminophen | 652 | $23K |
| Fentanyl | 175 | $21K |
| Oxycodone Hcl/Acetaminophen | 339 | $17K |
| Buprenorphine Hcl | 16 | $14K |
| Morphine Sulfate | 391 | $13K |
| Naloxegol Oxalate | 27 | $11K |
| Pregabalin | 246 | $6,850 |
| Naldemedine Tosylate | 14 | $5,685 |
| Gabapentin | 253 | $5,484 |
| Oxymorphone Hcl | 12 | $4,976 |
| Hydromorphone Hcl | 278 | $4,317 |
Prescribing Profile
36
Unique Drugs
26.0
Anomaly Score
Patient Profile
71
Avg Age
65%
Female
1.71
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