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
11,312
Total Claims
$1.2M
Drug Cost
389
Beneficiaries
$3,014
Cost/Patient
Risk Score Breakdown 44/100
Score components are additive. Read full methodology
Peer Comparison vs. 106,889 Family Practice providers
+769%
Opioid rate vs peers
22.4% vs 2.6% avg
+182%
Cost per patient vs peers
$3,014 vs $1,068 avg
+42%
Brand preference vs peers
12.8% 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 769% 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
22.4%
Opioid Rate
2,535
Opioid Claims
$156K
Opioid Cost
20.3%
Long-Acting Rate
This provider's opioid prescribing rate of 22.4% is above the 20% threshold that CMS considers elevated.
Brand vs Generic
Brand: 1,427 claims · $939K
Generic: 9,724 claims · $227K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Semaglutide | 75 | $92K |
| Apixaban | 98 | $87K |
| Dulaglutide | 76 | $84K |
| Oxycodone Hcl | 56 | $83K |
| Fluticasone/Umeclidin/Vilanter | 85 | $70K |
| Cariprazine Hcl | 31 | $51K |
| Rivaroxaban | 56 | $44K |
| Elviteg/Cob/Emtri/Tenof Alafen | 11 | $40K |
| Brexpiprazole | 23 | $32K |
| Empagliflozin | 18 | $25K |
| Sitagliptin Phosphate | 17 | $24K |
| Hydrocodone/Acetaminophen | 1,199 | $22K |
| Budesonide/Glycopyr/Formoterol | 28 | $21K |
| Budesonide/Formoterol Fumarate | 35 | $20K |
| Mirabegron | 29 | $19K |
Prescribing Profile
Patient Profile
69
Avg Age
52%
Female
1.35
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