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 →36
🟠 Elevated
🤖 ML Fraud Detection Score: 98%
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
9,288
Total Claims
$894K
Drug Cost
391
Beneficiaries
$2,288
Cost/Patient
Risk Score Breakdown 36/100
Score components are additive. Read full methodology
Peer Comparison vs. 7,404 Physical Medicine and Rehabilitation providers
+140%
Opioid rate vs peers
48.5% vs 20.2% avg
+402%
Cost per patient vs peers
$2,288 vs $455 avg
+148%
Brand preference vs peers
7.8% vs 3.1% 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
Our machine learning model — trained on 281 confirmed fraud cases — gives this provider a "Very High" fraud-pattern score. All 20 decision trees in our ensemble model agree that this provider's prescribing patterns resemble those of confirmed fraud cases. This is a statistical finding, not an accusation.
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
48.5%
Opioid Rate
4,503
Opioid Claims
$644K
Opioid Cost
25.4%
Long-Acting Rate
This provider's opioid prescribing rate of 48.5% is above the 20% threshold that CMS considers elevated.
Brand vs Generic
Brand: 724 claims · $518K
Generic: 8,551 claims · $376K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Oxycodone Hcl | 165 | $231K |
| Oxycodone Myristate | 97 | $112K |
| Oxycodone Hcl/Acetaminophen | 17 | $69K |
| Oxycodone Hcl/Acetaminophen | 1,207 | $61K |
| Oxycodone Hcl | 1,171 | $51K |
| Rimegepant Sulfate | 29 | $32K |
| Naloxegol Oxalate | 68 | $29K |
| Fentanyl | 247 | $26K |
| Morphine Sulfate | 497 | $23K |
| Oxymorphone Hcl | 19 | $20K |
| Hydrocodone/Acetaminophen | 462 | $16K |
| Ubrogepant | 12 | $15K |
| Pregabalin | 28 | $14K |
| Butalb/Acetaminophen/Caffeine | 81 | $13K |
| Galcanezumab-Gnlm | 17 | $12K |
Prescribing Profile
78
Unique Drugs
36.0
Anomaly Score
Patient Profile
68
Avg Age
61%
Female
1.75
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