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
8,557
Total Claims
$9.2M
Drug Cost
274
Beneficiaries
$33K
Cost/Patient
Risk Score Breakdown 36/100
Score components are additive. Read full methodology
Peer Comparison vs. 5,387 Infectious Disease providers
+317%
Cost per patient vs peers
$33K vs $8,010 avg
+85%
Brand preference vs peers
39.4% vs 21.3% 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
2.9%
Opioid Rate
249
Opioid Claims
$2,889
Opioid Cost
12.4%
Long-Acting Rate
Brand vs Generic
Brand: 3,340 claims · $8.8M
Generic: 5,128 claims · $396K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Bictegrav/Emtricit/Tenofov Ala | 472 | $2.0M |
| Emtricitabine/Tenofov Alafenam | 461 | $1.1M |
| Dolutegravir Sodium/Lamivudine | 339 | $1.0M |
| Dolutegravir Sodium | 275 | $682K |
| Emtricitab/Rilpiviri/Tenof Ala | 173 | $644K |
| Darunavir/Cob/Emtri/Tenof Alaf | 124 | $643K |
| Elviteg/Cob/Emtri/Tenof Alafen | 95 | $444K |
| Darunavir/Cobicistat | 164 | $427K |
| Abacavir/Dolutegravir/Lamivudi | 70 | $271K |
| Dolutegravir/Rilpivirine | 73 | $265K |
| Darunavir | 87 | $194K |
| Cabotegravir/Rilpivirine | 27 | $185K |
| Raltegravir Potassium | 83 | $173K |
| Efavirenz/Emtricit/Tenofovr Df | 57 | $93K |
| Efavirenz | 97 | $74K |
Prescribing Profile
Patient Profile
66
Avg Age
49%
Female
1.83
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