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: 85%
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
14,564
Total Claims
$1.1M
Drug Cost
940
Beneficiaries
$1,192
Cost/Patient
Risk Score Breakdown 41/100
Score components are additive. Read full methodology
Peer Comparison vs. 110,156 Internal Medicine providers
+452%
Opioid rate vs peers
12.3% vs 2.2% avg
-15%
Cost per patient vs peers
$1,192 vs $1,411 avg
-13%
Brand preference vs peers
9.3% 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 85% indicates prescribing patterns with significant similarity to confirmed fraud cases. 17 out of 20 decision trees flagged this provider.
Opioid rate is 452% above Internal Medicine peers. This is a significant deviation that may reflect a specialized patient population or concerning prescribing patterns.
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
12.3%
Opioid Rate
1,798
Opioid Claims
$175K
Opioid Cost
29.4%
Long-Acting Rate
Brand vs Generic
Brand: 1,344 claims · $746K
Generic: 13,154 claims · $370K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Apixaban | 102 | $129K |
| Dulaglutide | 61 | $89K |
| Oxycodone Hcl | 103 | $71K |
| Semaglutide | 47 | $51K |
| Oxycodone Hcl/Acetaminophen | 11 | $46K |
| Rivaroxaban | 29 | $29K |
| Insulin Glargine,hum.Rec.Anlog | 56 | $27K |
| Linaclotide | 35 | $26K |
| Insulin Aspart | 15 | $24K |
| Empagliflozin | 28 | $22K |
| Sitagliptin Phosphate | 21 | $21K |
| Oxycodone Hcl | 557 | $17K |
| Insulin Lispro | 22 | $17K |
| Atorvastatin Calcium | 597 | $14K |
| Fluticasone Propion/Salmeterol | 16 | $13K |
Prescribing Profile
Patient Profile
74
Avg Age
44%
Female
1.32
Avg Risk Score
Explore More
Data from CMS Medicare Part D Prescriber Public Use File, 2023. Risk scores are statistical indicators, not allegations.Methodology · About