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: 97%
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
9,149
Total Claims
$515K
Drug Cost
217
Beneficiaries
$2,373
Cost/Patient
Risk Score Breakdown 26/100
Score components are additive. Read full methodology
Peer Comparison vs. 13,124 General Surgery providers
-87%
Opioid rate vs peers
4.1% vs 30.2% avg
+839%
Cost per patient vs peers
$2,373 vs $253 avg
+95%
Brand preference vs peers
9.7% vs 5.0% 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.
Cost per patient is 839% above the specialty average. Extreme cost outliers may indicate prescribing of unnecessarily expensive brand-name drugs or inappropriate drug utilization.
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
4.1%
Opioid Rate
372
Opioid Claims
$6,339
Opioid Cost
3.2%
Long-Acting Rate
Brand vs Generic
Brand: 881 claims · $382K
Generic: 8,189 claims · $129K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Dapagliflozin Propanediol | 79 | $64K |
| Sitagliptin Phosphate | 50 | $37K |
| Apixaban | 57 | $34K |
| Umeclidinium Brm/Vilanterol Tr | 32 | $16K |
| Dulaglutide | 17 | $14K |
| Fluticasone/Vilanterol | 24 | $14K |
| Linaclotide | 22 | $12K |
| Fluticasone/Umeclidin/Vilanter | 17 | $12K |
| Insulin Detemir | 22 | $12K |
| Insulin Glargine,hum.Rec.Anlog | 48 | $11K |
| Mirabegron | 13 | $11K |
| Budesonide/Formoterol Fumarate | 24 | $11K |
| Insulin Nph Hum/Reg Insulin Hm | 13 | $11K |
| Irbesartan | 294 | $10K |
| Insulin Glargine,hum.Rec.Anlog | 18 | $7,534 |
Prescribing Profile
Patient Profile
70
Avg Age
55%
Female
1.41
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