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 →35
🟠 Elevated
🤖 ML Fraud Detection Score: 91%
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
6,490
Total Claims
$326K
Drug Cost
312
Beneficiaries
$1,043
Cost/Patient
Risk Score Breakdown 35/100
Score components are additive. Read full methodology
Peer Comparison vs. 1,498 Interventional Pain Management providers
+33%
Opioid rate vs peers
61.2% vs 45.9% avg
+116%
Cost per patient vs peers
$1,043 vs $483 avg
-7%
Brand preference vs peers
3.9% vs 4.1% 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 91% 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
61.2%
Opioid Rate
3,975
Opioid Claims
$270K
Opioid Cost
46.7%
Long-Acting Rate
This provider's opioid prescribing rate of 61.2% is above the 20% threshold that CMS considers elevated.
Brand vs Generic
Brand: 250 claims · $156K
Generic: 6,240 claims · $170K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Oxycodone Hcl | 123 | $112K |
| Fentanyl | 377 | $41K |
| Tapentadol Hcl | 24 | $26K |
| Oxycodone Hcl/Acetaminophen | 916 | $24K |
| Morphine Sulfate | 853 | $23K |
| Hydrocodone/Acetaminophen | 626 | $14K |
| Methadone Hcl | 485 | $12K |
| Buprenorphine | 18 | $8,522 |
| Pregabalin | 111 | $8,387 |
| Suvorexant | 15 | $6,787 |
| Oxycodone Hcl | 417 | $6,266 |
| Gabapentin | 204 | $4,694 |
| Tizanidine Hcl | 229 | $3,172 |
| Cyclobenzaprine Hcl | 235 | $2,105 |
| Morphine Sulfate | 60 | $1,500 |
Prescribing Profile
46
Unique Drugs
35.0
Anomaly Score
Patient Profile
65
Avg Age
57%
Female
1.84
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