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: 98%
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
9,683
Total Claims
$734K
Drug Cost
353
Beneficiaries
$2,080
Cost/Patient
Risk Score Breakdown 39/100
Score components are additive. Read full methodology
Peer Comparison vs. 106,889 Family Practice providers
+733%
Opioid rate vs peers
21.5% vs 2.6% avg
+95%
Cost per patient vs peers
$2,080 vs $1,068 avg
+8%
Brand preference vs peers
9.7% vs 9.0% 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
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.
Opioid prescribing rate is 733% above the average for Family Practice providers. While some providers legitimately treat pain-heavy populations, deviations of this magnitude are rare and warrant examination.
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
21.5%
Opioid Rate
2,081
Opioid Claims
$63K
Opioid Cost
—
Long-Acting Rate
This provider's opioid prescribing rate of 21.5% is above the 20% threshold that CMS considers elevated.
Brand vs Generic
Brand: 938 claims · $547K
Generic: 8,707 claims · $186K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Dulaglutide | 104 | $117K |
| Empagliflozin | 47 | $67K |
| Linagliptin | 47 | $43K |
| Hydrocodone/Acetaminophen | 1,389 | $43K |
| Tiotropium Bromide | 41 | $31K |
| Apixaban | 28 | $29K |
| Fluticasone/Umeclidin/Vilanter | 42 | $29K |
| Semaglutide | 23 | $29K |
| Oxycodone Hcl/Acetaminophen | 507 | $17K |
| Budesonide/Formoterol Fumarate | 31 | $15K |
| Linaclotide | 15 | $14K |
| Insulin Glargine,hum.Rec.Anlog | 22 | $14K |
| Sitagliptin Phosphate | 11 | $11K |
| Insulin Degludec | 13 | $9,716 |
| Insulin Glargine,hum.Rec.Anlog | 15 | $8,541 |
Prescribing Profile
Patient Profile
68
Avg Age
51%
Female
1.39
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