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: 95%
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
8,573
Total Claims
$381K
Drug Cost
350
Beneficiaries
$1,089
Cost/Patient
Risk Score Breakdown 24/100
Score components are additive. Read full methodology
Peer Comparison vs. 2,621 Pain Management providers
-16%
Opioid rate vs peers
34.8% vs 41.3% avg
+173%
Cost per patient vs peers
$1,089 vs $399 avg
-40%
Brand preference vs peers
2.2% vs 3.8% 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.
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
34.8%
Opioid Rate
2,982
Opioid Claims
$119K
Opioid Cost
10.6%
Long-Acting Rate
This provider's opioid prescribing rate of 34.8% is above the 20% threshold that CMS considers elevated.
Brand vs Generic
Brand: 192 claims · $151K
Generic: 8,381 claims · $231K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Hydrocodone/Acetaminophen | 1,832 | $67K |
| Rimegepant Sulfate | 34 | $38K |
| Rotigotine | 22 | $27K |
| Buprenorphine Hcl/Naloxone Hcl | 99 | $27K |
| Gabapentin | 1,284 | $21K |
| Oxycodone Myristate | 17 | $18K |
| Oxycodone Hcl/Acetaminophen | 482 | $18K |
| Lidocaine | 85 | $12K |
| Ropinirole Hcl | 817 | $9,748 |
| Diclofenac Sodium | 135 | $8,322 |
| Duloxetine Hcl | 302 | $7,864 |
| Pregabalin | 229 | $7,653 |
| Pregabalin | 12 | $7,423 |
| Duloxetine Hcl | 12 | $7,201 |
| Morphine Sulfate | 249 | $7,093 |
Prescribing Profile
41
Unique Drugs
24.0
Anomaly Score
Patient Profile
63
Avg Age
62%
Female
1.61
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