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: 90%
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
11,840
Total Claims
$1.8M
Drug Cost
643
Beneficiaries
$2,797
Cost/Patient
Risk Score Breakdown 26/100
Score components are additive. Read full methodology
Peer Comparison vs. 106,889 Family Practice providers
+470%
Opioid rate vs peers
14.7% vs 2.6% avg
+162%
Cost per patient vs peers
$2,797 vs $1,068 avg
+47%
Brand preference vs peers
13.2% vs 9.0% 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 90% indicates prescribing patterns with significant similarity to confirmed fraud cases. 18 out of 20 decision trees flagged this provider.
Opioid rate is 470% above Family Practice peers. This is a significant deviation that may reflect a specialized patient population or concerning prescribing patterns.
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
14.7%
Opioid Rate
1,741
Opioid Claims
$35K
Opioid Cost
3.3%
Long-Acting Rate
Brand vs Generic
Brand: 1,544 claims · $1.4M
Generic: 10,143 claims · $398K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Etanercept | 14 | $108K |
| Metformin Hcl | 22 | $107K |
| Adalimumab | 12 | $89K |
| Adalimumab | 11 | $84K |
| Tirzepatide | 73 | $83K |
| Diclofenac Sodium | 168 | $74K |
| Denosumab | 42 | $71K |
| Rivaroxaban | 77 | $67K |
| Apixaban | 69 | $61K |
| Dulaglutide | 52 | $59K |
| Insulin Glargine,hum.Rec.Anlog | 76 | $59K |
| Semaglutide | 36 | $57K |
| Semaglutide | 41 | $56K |
| Sitagliptin Phosphate | 52 | $54K |
| Insulin Glargine,hum.Rec.Anlog | 54 | $36K |
Prescribing Profile
Patient Profile
70
Avg Age
61%
Female
1.59
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