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 →Risk Flags
Risk indicators are statistical patterns, not allegations. Learn more
8,836
Total Claims
$2.5M
Drug Cost
655
Beneficiaries
$3,827
Cost/Patient
Risk Score Breakdown 30/100
Score components are additive. Read full methodology
Peer Comparison vs. 5,101 Rheumatology providers
+684%
Opioid rate vs peers
31.8% vs 4.1% avg
-37%
Cost per patient vs peers
$3,827 vs $6,039 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
Opioid prescribing rate is 684% above the average for Rheumatology 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
31.8%
Opioid Rate
2,812
Opioid Claims
$82K
Opioid Cost
0.4%
Long-Acting Rate
This provider's opioid prescribing rate of 31.8% is above the 20% threshold that CMS considers elevated.
Brand vs Generic
Brand: 0 claims · $0
Generic: 8,341 claims · $300K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Etanercept | 49 | $357K |
| Upadacitinib | 42 | $275K |
| Tofacitinib Citrate | 40 | $239K |
| Etanercept | 22 | $154K |
| Tofacitinib Citrate | 27 | $150K |
| Adalimumab | 15 | $141K |
| Adalimumab | 17 | $127K |
| Abatacept | 15 | $87K |
| Etanercept | 11 | $76K |
| Apremilast | 15 | $71K |
| Hydrocodone/Acetaminophen | 1,765 | $45K |
| Hydroxychloroquine Sulfate | 634 | $40K |
| Methotrexate Sodium | 664 | $17K |
| Leflunomide | 267 | $16K |
| Celecoxib | 128 | $16K |
Prescribing Profile
Patient Profile
65
Avg Age
76%
Female
1.65
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