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: 85%
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
10,282
Total Claims
$951K
Drug Cost
504
Beneficiaries
$1,886
Cost/Patient
Risk Score Breakdown 13/100
Score components are additive. Read full methodology
Peer Comparison vs. 7,389 General Practice providers
+89%
Opioid rate vs peers
4.7% vs 2.5% avg
+67%
Cost per patient vs peers
$1,886 vs $1,128 avg
+9%
Brand preference vs peers
9.2% vs 8.4% 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 85% indicates prescribing patterns with significant similarity to confirmed fraud cases. 17 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
4.7%
Opioid Rate
482
Opioid Claims
$9,270
Opioid Cost
7.5%
Long-Acting Rate
Brand vs Generic
Brand: 937 claims · $768K
Generic: 9,288 claims · $179K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Semaglutide | 106 | $171K |
| Apixaban | 80 | $85K |
| Rivaroxaban | 54 | $67K |
| Insulin Glargine,hum.Rec.Anlog | 34 | $52K |
| Insulin Aspart | 15 | $35K |
| Insulin Detemir | 19 | $24K |
| Insulin Detemir | 15 | $13K |
| Fluticasone Propion/Salmeterol | 12 | $9,186 |
| Ipratropium/Albuterol Sulfate | 12 | $6,895 |
| Levothyroxine Sodium | 384 | $5,694 |
| Gabapentin | 349 | $5,239 |
| Levothyroxine Sodium | 63 | $5,182 |
| Esomeprazole Magnesium | 37 | $4,786 |
| Omeprazole | 294 | $4,089 |
| Metoprolol Succinate | 201 | $4,029 |
Prescribing Profile
Patient Profile
72
Avg Age
50%
Female
0.95
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