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: 93%
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
12,190
Total Claims
$5.9M
Drug Cost
335
Beneficiaries
$18K
Cost/Patient
Risk Score Breakdown 43/100
Score components are additive. Read full methodology
Peer Comparison vs. 110,156 Internal Medicine providers
+10%
Opioid rate vs peers
2.5% vs 2.2% avg
+1150%
Cost per patient vs peers
$18K vs $1,411 avg
+291%
Brand preference vs peers
41.5% vs 10.6% 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 93% indicates prescribing patterns with significant similarity to confirmed fraud cases. 19 out of 20 decision trees flagged this provider.
Cost per patient is 1150% above the specialty average. Extreme cost outliers may indicate prescribing of unnecessarily expensive brand-name drugs or inappropriate drug utilization.
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
2.5%
Opioid Rate
299
Opioid Claims
$12K
Opioid Cost
—
Long-Acting Rate
Brand vs Generic
Brand: 4,992 claims · $5.3M
Generic: 7,032 claims · $590K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Diclofenac Sodium | 464 | $1.4M |
| Lipase/Protease/Amylase | 232 | $559K |
| Ibuprofen/Famotidine | 102 | $278K |
| Naproxen/Esomeprazole Mag | 98 | $276K |
| Lipase/Protease/Amylase | 189 | $270K |
| Linaclotide | 395 | $227K |
| Diclofenac Sodium | 234 | $194K |
| Icosapent Ethyl | 476 | $190K |
| Dihydroergotamine Mesylate | 82 | $152K |
| Naproxen/Esomeprazole Mag | 120 | $150K |
| Mirabegron | 287 | $144K |
| Dulaglutide | 93 | $103K |
| Semaglutide | 84 | $89K |
| Omeprazole/Sodium Bicarbonate | 60 | $86K |
| Memantine Hcl/Donepezil Hcl | 138 | $84K |
Prescribing Profile
Patient Profile
73
Avg Age
55%
Female
1.56
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