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: 86%
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
9,579
Total Claims
$829K
Drug Cost
649
Beneficiaries
$1,278
Cost/Patient
Risk Score Breakdown 15/100
Score components are additive. Read full methodology
Peer Comparison vs. 2,743 Pediatric Medicine providers
+210%
Opioid rate vs peers
4.9% vs 1.6% avg
-39%
Cost per patient vs peers
$1,278 vs $2,098 avg
-27%
Brand preference vs peers
11.0% vs 15.1% 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 86% indicates prescribing patterns with significant similarity to confirmed fraud cases. 17 out of 20 decision trees flagged this provider.
Opioid rate is 210% above Pediatric 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
4.9%
Opioid Rate
473
Opioid Claims
$11K
Opioid Cost
2.7%
Long-Acting Rate
Brand vs Generic
Brand: 1,045 claims · $655K
Generic: 8,470 claims · $170K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Apixaban | 86 | $81K |
| Empagliflozin | 60 | $62K |
| Sitagliptin Phosphate | 46 | $61K |
| Insulin Glargine,hum.Rec.Anlog | 48 | $45K |
| Fluticasone/Umeclidin/Vilanter | 52 | $39K |
| Semaglutide | 35 | $37K |
| Dulaglutide | 32 | $35K |
| Mirabegron | 22 | $29K |
| Emtricitabine/Tenofov Alafenam | 11 | $25K |
| Insulin Regular, Human | 19 | $20K |
| Insulin Lispro | 16 | $17K |
| Insulin Nph Human Isophane | 12 | $15K |
| Fluticasone/Vilanterol | 15 | $14K |
| Fluticasone Propion/Salmeterol | 29 | $11K |
| Hydrocodone/Acetaminophen | 295 | $8,681 |
Prescribing Profile
Patient Profile
74
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