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: 84%
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
27,241
Total Claims
$1.6M
Drug Cost
653
Beneficiaries
$2,519
Cost/Patient
Risk Score Breakdown 26/100
Score components are additive. Read full methodology
Peer Comparison vs. 44,021 Emergency Medicine providers
-86%
Opioid rate vs peers
1.3% vs 9.4% avg
+588%
Brand preference vs peers
10.2% vs 1.5% avg
⚠️ This provider has metrics more than 3 standard deviations above their specialty average in one or more categories.
⚠️ 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 84% indicates prescribing patterns with significant similarity to confirmed fraud cases. 17 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
1.3%
Opioid Rate
359
Opioid Claims
$3,206
Opioid Cost
—
Long-Acting Rate
Brand vs Generic
Brand: 2,767 claims · $1.3M
Generic: 24,330 claims · $335K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Apixaban | 556 | $175K |
| Semaglutide | 35 | $75K |
| Dapagliflozin Propanediol | 48 | $67K |
| Fluticasone/Umeclidin/Vilanter | 49 | $64K |
| Rivaroxaban | 150 | $62K |
| Insulin Glargine,hum.Rec.Anlog | 86 | $48K |
| Dulaglutide | 46 | $47K |
| Ipratropium/Albuterol Sulfate | 35 | $47K |
| Budesonide/Formoterol Fumarate | 50 | $46K |
| Insulin Degludec | 11 | $44K |
| Insulin Detemir | 75 | $38K |
| Insulin Glargine,hum.Rec.Anlog | 20 | $28K |
| Sitagliptin Phosphate | 65 | $27K |
| Insulin Aspart | 76 | $24K |
| Insulin Aspart | 25 | $23K |
Prescribing Profile
Patient Profile
72
Avg Age
52%
Female
1.58
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