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
88,528
Total Claims
$10.8M
Drug Cost
984
Beneficiaries
$11K
Cost/Patient
Risk Score Breakdown 33/100
Score components are additive. Read full methodology
Peer Comparison vs. 7,389 General Practice providers
-41%
Opioid rate vs peers
1.5% vs 2.5% avg
+875%
Cost per patient vs peers
$11K vs $1,128 avg
+91%
Brand preference vs peers
16.1% vs 8.4% avg
⚠️ This provider has metrics more than 3 standard deviations above their specialty average in one or more categories.
⚠️ 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 875% 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
1.5%
Opioid Rate
1,301
Opioid Claims
$14K
Opioid Cost
—
Long-Acting Rate
Brand vs Generic
Brand: 14,057 claims · $6.6M
Generic: 73,384 claims · $4.2M
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Omeprazole/Sodium Bicarbonate | 408 | $785K |
| Lipase/Protease/Amylase | 793 | $690K |
| Icosapent Ethyl | 1,706 | $645K |
| Linaclotide | 970 | $563K |
| Metformin Hcl | 181 | $360K |
| Semaglutide | 309 | $321K |
| Diclofenac Sodium | 2,048 | $283K |
| Mirabegron | 537 | $276K |
| Sitagliptin Phos/Metformin Hcl | 393 | $260K |
| Dexlansoprazole | 978 | $243K |
| Cyclosporine | 341 | $240K |
| Fluticasone/Umeclidin/Vilanter | 268 | $189K |
| Rivaroxaban | 293 | $187K |
| Empagliflozin/Metformin Hcl | 257 | $187K |
| Memantine Hcl | 896 | $172K |
Prescribing Profile
Patient Profile
73
Avg Age
51%
Female
1.30
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