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: 92%
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
100,070
Total Claims
$9.5M
Drug Cost
2,606
Beneficiaries
$3,653
Cost/Patient
Risk Score Breakdown 26/100
Score components are additive. Read full methodology
Peer Comparison vs. 16,767 Hospitalist providers
-33%
Opioid rate vs peers
2.0% vs 3.0% avg
+755%
Cost per patient vs peers
$3,653 vs $427 avg
+226%
Brand preference vs peers
17.1% vs 5.2% 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 92% indicates prescribing patterns with significant similarity to confirmed fraud cases. 18 out of 20 decision trees flagged this provider.
Cost per patient is 755% 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
2.0%
Opioid Rate
1,991
Opioid Claims
$36K
Opioid Cost
6.4%
Long-Acting Rate
Brand vs Generic
Brand: 16,916 claims · $7.2M
Generic: 82,078 claims · $2.3M
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Valbenazine Tosylate | 274 | $1.4M |
| Apixaban | 2,312 | $726K |
| Sacubitril/Valsartan | 1,237 | $421K |
| Empagliflozin | 1,163 | $380K |
| Dapagliflozin Propanediol | 1,110 | $337K |
| Dulaglutide | 417 | $258K |
| Paliperidone Palmitate | 79 | $220K |
| Semaglutide | 193 | $208K |
| Rivaroxaban | 495 | $154K |
| Liraglutide | 230 | $137K |
| Divalproex Sodium | 1,514 | $110K |
| Mirabegron | 415 | $106K |
| Insulin Glargine,hum.Rec.Anlog | 416 | $88K |
| Tetrabenazine | 21 | $87K |
| Linaclotide | 156 | $86K |
Prescribing Profile
Patient Profile
74
Avg Age
55%
Female
2.31
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