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: 85%
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
8,735
Total Claims
$326K
Drug Cost
579
Beneficiaries
$563
Cost/Patient
Risk Score Breakdown 26/100
Score components are additive. Read full methodology
Peer Comparison vs. 218,535 Nurse Practitioner providers
+806%
Opioid rate vs peers
34.3% vs 3.8% avg
-52%
Cost per patient vs peers
$563 vs $1,174 avg
-56%
Brand preference vs peers
3.9% vs 8.9% 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 85% indicates prescribing patterns with significant similarity to confirmed fraud cases. 17 out of 20 decision trees flagged this provider.
Opioid prescribing rate is 806% above the average for Nurse Practitioner 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
34.3%
Opioid Rate
2,993
Opioid Claims
$152K
Opioid Cost
1.7%
Long-Acting Rate
This provider's opioid prescribing rate of 34.3% is above the 20% threshold that CMS considers elevated.
Brand vs Generic
Brand: 338 claims · $65K
Generic: 8,397 claims · $261K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Oxycodone Hcl/Acetaminophen | 1,105 | $59K |
| Oxycodone Hcl/Acetaminophen | 13 | $34K |
| Gabapentin | 1,269 | $21K |
| Hydrocodone/Acetaminophen | 891 | $20K |
| Diclofenac Sodium | 237 | $14K |
| Pregabalin | 361 | $12K |
| Tizanidine Hcl | 689 | $11K |
| Lidocaine | 70 | $10K |
| Oxycodone Hcl | 502 | $9,139 |
| Cyclobenzaprine Hcl | 628 | $8,903 |
| Celecoxib | 206 | $6,652 |
| Lidocaine | 18 | $6,584 |
| Buprenorphine Hcl/Naloxone Hcl | 48 | $5,313 |
| Buprenorphine Hcl/Naloxone Hcl | 11 | $5,094 |
| Duloxetine Hcl | 218 | $4,446 |
Prescribing Profile
39
Unique Drugs
26.0
Anomaly Score
Patient Profile
63
Avg Age
63%
Female
1.69
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