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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.

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Philip SmithMD

Internal Medicine · Cedar City, UT 84720

NPI: 1134142698

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24

🟡 Moderate

🤖 ML Fraud Detection Score: 87%

Machine learning model identifies prescribing patterns consistent with confirmed fraud cases. This is a statistical indicator, not an accusation.

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Risk Flags

High antipsychotic prescribing (65+)Opioid + benzodiazepine co-prescriberHigh fills per patient

Risk indicators are statistical patterns, not allegations. Learn more

14,650

Total Claims

$1.4M

Drug Cost

753

Beneficiaries

$1,916

Cost/Patient

Risk Score Breakdown 24/100

Low (0)Moderate (15)Elevated (30)High (50+)
Elderly antipsychotic prescribing+10
Opioid + benzodiazepine combo+8
High fills per patient+3

Score components are additive. Read full methodology

Peer Comparison vs. 110,156 Internal Medicine providers

-54%

Opioid rate vs peers

1.0% vs 2.2% avg

+36%

Cost per patient vs peers

$1,916 vs $1,411 avg

+16%

Brand preference vs peers

12.4% 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.

Opioid Prescribing

1.0%

Opioid Rate

151

Opioid Claims

$2,691

Opioid Cost

Long-Acting Rate

Brand vs Generic

88% generic

Brand: 1,797 claims · $1.1M

Generic: 12,730 claims · $282K

Top Prescribed Drugs

Drug (Generic)ClaimsCost
Apixaban201$194K
Empagliflozin115$119K
Dulaglutide77$93K
Rivaroxaban100$89K
Insulin Glargine,hum.Rec.Anlog87$53K
Semaglutide29$42K
Insulin Lispro39$41K
Insulin Glargine,hum.Rec.Anlog29$38K
Insulin Aspart44$37K
Insulin Glargine,hum.Rec.Anlog28$27K
Semaglutide22$26K
Budesonide/Formoterol Fumarate42$24K
Insulin Detemir21$23K
Dapagliflozin Propanediol28$22K
Cariprazine Hcl25$17K

Prescribing Profile

171

Unique Drugs

$489K

IRA Negotiated Drugs

$162K

GLP-1 Drugs

24.0

Anomaly Score

Patient Profile

73

Avg Age

51%

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