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
13,290
Total Claims
$6.6M
Drug Cost
2,209
Beneficiaries
$2,983
Cost/Patient
Risk Score Breakdown 44/100
Score components are additive. Read full methodology
Peer Comparison vs. 5,101 Rheumatology providers
+883%
Opioid rate vs peers
39.9% vs 4.1% avg
-51%
Cost per patient vs peers
$2,983 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 883% 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
39.9%
Opioid Rate
5,302
Opioid Claims
$305K
Opioid Cost
5.4%
Long-Acting Rate
This provider's opioid prescribing rate of 39.9% is above the 20% threshold that CMS considers elevated.
Brand vs Generic
Brand: 0 claims · $0
Generic: 12,285 claims · $424K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Adalimumab | 372 | $3.5M |
| Etanercept | 120 | $895K |
| Upadacitinib | 69 | $463K |
| Adalimumab | 30 | $241K |
| Sarilumab | 41 | $189K |
| Etanercept | 19 | $139K |
| Abatacept | 18 | $100K |
| Oxycodone Hcl/Acetaminophen | 1,476 | $89K |
| Hydrocodone/Acetaminophen | 2,455 | $85K |
| Belimumab | 16 | $77K |
| Apremilast | 11 | $64K |
| Methotrexate Sodium | 1,003 | $33K |
| Oxycodone Myristate | 35 | $29K |
| Buprenorphine Hcl | 31 | $26K |
| Hydroxychloroquine Sulfate | 434 | $19K |
Prescribing Profile
Patient Profile
68
Avg Age
69%
Female
1.74
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