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
26,336
Total Claims
$2.5M
Drug Cost
1,360
Beneficiaries
$1,853
Cost/Patient
Risk Score Breakdown 24/100
Score components are additive. Read full methodology
Peer Comparison vs. 2,743 Pediatric Medicine providers
+49%
Opioid rate vs peers
2.4% vs 1.6% avg
-12%
Cost per patient vs peers
$1,853 vs $2,098 avg
-13%
Brand preference vs peers
13.1% 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 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
2.4%
Opioid Rate
625
Opioid Claims
$12K
Opioid Cost
2.1%
Long-Acting Rate
Brand vs Generic
Brand: 3,425 claims · $2.1M
Generic: 22,764 claims · $398K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Semaglutide | 199 | $252K |
| Empagliflozin | 202 | $233K |
| Apixaban | 197 | $226K |
| Dapagliflozin Propanediol | 227 | $208K |
| Rivaroxaban | 91 | $110K |
| Sitagliptin Phosphate | 91 | $101K |
| Insulin Glargine,hum.Rec.Anlog | 126 | $89K |
| Dulaglutide | 65 | $81K |
| Mirabegron | 91 | $70K |
| Rsvpref3 Antigen/As01e/Pf | 194 | $62K |
| Fluticasone/Umeclidin/Vilanter | 80 | $57K |
| Linagliptin | 78 | $56K |
| Tirzepatide | 42 | $48K |
| Budesonide/Glycopyr/Formoterol | 40 | $35K |
| Budesonide/Formoterol Fumarate | 65 | $30K |
Prescribing Profile
Patient Profile
75
Avg Age
59%
Female
1.04
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