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: 92%
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
9,480
Total Claims
$955K
Drug Cost
603
Beneficiaries
$1,584
Cost/Patient
Risk Score Breakdown 21/100
Score components are additive. Read full methodology
Peer Comparison vs. 110,156 Internal Medicine providers
-59%
Opioid rate vs peers
0.9% vs 2.2% avg
+12%
Cost per patient vs peers
$1,584 vs $1,411 avg
+9%
Brand preference vs peers
11.6% 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
ML fraud detection score of 92% indicates prescribing patterns with significant similarity to confirmed fraud cases. 18 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
0.9%
Opioid Rate
88
Opioid Claims
$728
Opioid Cost
—
Long-Acting Rate
Brand vs Generic
Brand: 1,097 claims · $775K
Generic: 8,352 claims · $179K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Empagliflozin | 132 | $145K |
| Semaglutide | 120 | $142K |
| Tirzepatide | 86 | $113K |
| Apixaban | 118 | $110K |
| Dulaglutide | 68 | $75K |
| Mirabegron | 34 | $28K |
| Budesonide/Formoterol Fumarate | 35 | $18K |
| Fluticasone/Umeclidin/Vilanter | 20 | $14K |
| Atorvastatin Calcium | 802 | $10K |
| Fluticasone/Vilanterol | 16 | $7,722 |
| Tamsulosin Hcl | 247 | $6,899 |
| Fluticasone Propion/Salmeterol | 11 | $6,897 |
| Fluticasone Propion/Salmeterol | 12 | $6,732 |
| Levothyroxine Sodium | 439 | $6,210 |
| Pantoprazole Sodium | 279 | $5,438 |
Prescribing Profile
Patient Profile
76
Avg Age
32%
Female
1.07
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