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: 88%
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
10,047
Total Claims
$670K
Drug Cost
269
Beneficiaries
$2,489
Cost/Patient
Risk Score Breakdown 36/100
Score components are additive. Read full methodology
Peer Comparison vs. 110,156 Internal Medicine providers
-7%
Opioid rate vs peers
2.1% vs 2.2% avg
+76%
Cost per patient vs peers
$2,489 vs $1,411 avg
+22%
Brand preference vs peers
12.9% vs 10.6% 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
ML fraud detection score of 88% indicates prescribing patterns with significant similarity to confirmed fraud cases. 18 out of 20 decision trees flagged this provider.
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
2.1%
Opioid Rate
210
Opioid Claims
$2,400
Opioid Cost
26.2%
Long-Acting Rate
Brand vs Generic
Brand: 1,289 claims · $495K
Generic: 8,684 claims · $170K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Apixaban | 278 | $151K |
| Rivaroxaban | 109 | $52K |
| Mirabegron | 60 | $29K |
| Fluticasone/Umeclidin/Vilanter | 24 | $18K |
| Insulin Lispro-Aabc | 16 | $15K |
| Insulin Degludec | 22 | $14K |
| Fluticasone/Vilanterol | 31 | $13K |
| Insulin Glargine,hum.Rec.Anlog | 27 | $12K |
| Cinacalcet Hcl | 13 | $11K |
| Empagliflozin | 13 | $7,466 |
| Dapagliflozin Propanediol | 11 | $6,064 |
| Cyclosporine | 18 | $6,041 |
| Rivastigmine | 28 | $5,407 |
| Cyclosporine | 23 | $5,226 |
| Duloxetine Hcl | 247 | $5,198 |
Prescribing Profile
Patient Profile
85
Avg Age
73%
Female
2.92
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