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
14,575
Total Claims
$1.5M
Drug Cost
253
Beneficiaries
$5,907
Cost/Patient
Risk Score Breakdown 41/100
Score components are additive. Read full methodology
Peer Comparison vs. 110,156 Internal Medicine providers
+591%
Opioid rate vs peers
15.5% vs 2.2% avg
+319%
Cost per patient vs peers
$5,907 vs $1,411 avg
+25%
Brand preference vs peers
13.3% 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 prescribing rate is 591% above the average for Internal Medicine 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
15.5%
Opioid Rate
2,255
Opioid Claims
$90K
Opioid Cost
7.7%
Long-Acting Rate
Brand vs Generic
Brand: 1,924 claims · $1.2M
Generic: 12,578 claims · $259K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Semaglutide | 107 | $133K |
| Tiotropium Bromide | 101 | $99K |
| Empagliflozin | 64 | $83K |
| Fluticasone/Vilanterol | 123 | $74K |
| Fluticasone/Umeclidin/Vilanter | 70 | $69K |
| Icosapent Ethyl | 121 | $56K |
| Apixaban | 47 | $46K |
| Dapagliflozin Propanediol | 43 | $38K |
| Hydrocodone/Acetaminophen | 1,300 | $38K |
| Tiotropium Bromide | 42 | $34K |
| Sitagliptin Phosphate | 23 | $34K |
| Dulaglutide | 20 | $32K |
| Insulin Glargine,hum.Rec.Anlog | 39 | $31K |
| Fluticasone Propionate | 92 | $28K |
| Budesonide/Glycopyr/Formoterol | 26 | $26K |
Prescribing Profile
Patient Profile
65
Avg Age
53%
Female
1.41
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