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
19,630
Total Claims
$2.5M
Drug Cost
1,136
Beneficiaries
$2,195
Cost/Patient
Risk Score Breakdown 21/100
Score components are additive. Read full methodology
Peer Comparison vs. 2,743 Pediatric Medicine providers
+178%
Opioid rate vs peers
4.4% vs 1.6% avg
+5%
Cost per patient vs peers
$2,195 vs $2,098 avg
-11%
Brand preference vs peers
13.3% 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 85% indicates prescribing patterns with significant similarity to confirmed fraud cases. 17 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
4.4%
Opioid Rate
868
Opioid Claims
$36K
Opioid Cost
11.5%
Long-Acting Rate
Brand vs Generic
Brand: 2,590 claims · $2.1M
Generic: 16,826 claims · $368K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Semaglutide | 286 | $412K |
| Apixaban | 228 | $296K |
| Dapagliflozin Propanediol | 171 | $187K |
| Empagliflozin | 101 | $110K |
| Fluticasone/Umeclidin/Vilanter | 61 | $78K |
| Linaclotide | 72 | $74K |
| Dulaglutide | 47 | $71K |
| Insulin Glargine,hum.Rec.Anlog | 58 | $41K |
| Insulin Detemir | 52 | $40K |
| Insulin Aspart | 27 | $29K |
| Rivaroxaban | 26 | $28K |
| Semaglutide | 17 | $27K |
| Insulin Lispro | 22 | $26K |
| Insulin Glargine,hum.Rec.Anlog | 26 | $25K |
| Sitagliptin Phosphate | 29 | $25K |
Prescribing Profile
Patient Profile
71
Avg Age
53%
Female
1.45
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