⚠️

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 →

Mark HigginsMD

Internal Medicine · San Francisco, CA 94114

NPI: 1134193469

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33

🟠 Elevated

Risk Flags

Extreme cost outlier (population + peer)High long-acting opioid rate vs peersOpioid + benzodiazepine co-prescriberHigh fills per patient

Risk indicators are statistical patterns, not allegations. Learn more

13,258

Total Claims

$10.3M

Drug Cost

607

Beneficiaries

$17K

Cost/Patient

Risk Score Breakdown 33/100

Low (0)Moderate (15)Elevated (30)High (50+)
Cost per patient outlier+10
Long-acting opioid rate+8
Opioid + benzodiazepine combo+8
High fills per patient+3

Score components are additive. Read full methodology

Peer Comparison vs. 110,156 Internal Medicine providers

+45%

Opioid rate vs peers

3.3% vs 2.2% avg

+1098%

Cost per patient vs peers

$17K vs $1,411 avg

+173%

Brand preference vs peers

29.1% vs 10.6% 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

💰

Cost per patient is 1098% above the specialty average. Extreme cost outliers may indicate prescribing of unnecessarily expensive brand-name drugs or inappropriate drug utilization.

⚠️

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

3.3%

Opioid Rate

431

Opioid Claims

$55K

Opioid Cost

33.2%

Long-Acting Rate

Brand vs Generic

71% generic

Brand: 3,837 claims · $9.7M

Generic: 9,369 claims · $543K

Top Prescribed Drugs

Drug (Generic)ClaimsCost
Bictegrav/Emtricit/Tenofov Ala332$1.6M
Somatropin48$883K
Dolutegravir Sodium282$803K
Abacavir/Dolutegravir/Lamivudi208$788K
Emtricitab/Rilpiviri/Tenof Ala198$783K
Emtricitabine/Tenofov Alafenam267$641K
Elviteg/Cob/Emtri/Tenof Alafen90$396K
Dolutegravir Sodium/Lamivudine106$365K
Dolutegravir/Rilpivirine103$358K
Darunavir/Cob/Emtri/Tenof Alaf70$351K
Raltegravir Potassium160$323K
Tesamorelin Acetate32$250K
Doravirine101$182K
Darunavir80$172K
Lipase/Protease/Amylase62$157K

Prescribing Profile

188

Unique Drugs

$302K

IRA Negotiated Drugs

$236K

GLP-1 Drugs

33.0

Anomaly Score

Patient Profile

71

Avg Age

14%

Female

1.33

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