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 →21
🟡 Moderate
🤖 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
6,218
Total Claims
$656K
Drug Cost
369
Beneficiaries
$1,779
Cost/Patient
Risk Score Breakdown 21/100
Score components are additive. Read full methodology
Peer Comparison vs. 1,498 Interventional Pain Management providers
+23%
Opioid rate vs peers
56.4% vs 45.9% avg
+268%
Cost per patient vs peers
$1,779 vs $483 avg
+166%
Brand preference vs peers
11.0% 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
56.4%
Opioid Rate
3,509
Opioid Claims
$538K
Opioid Cost
31.2%
Long-Acting Rate
This provider's opioid prescribing rate of 56.4% is above the 20% threshold that CMS considers elevated.
Brand vs Generic
Brand: 684 claims · $440K
Generic: 5,534 claims · $217K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Tapentadol Hcl | 105 | $183K |
| Oxycodone Myristate | 62 | $68K |
| Oxycodone Hcl | 52 | $53K |
| Tapentadol Hcl | 40 | $47K |
| Oxycodone Hcl/Acetaminophen | 808 | $37K |
| Morphine Sulfate | 552 | $29K |
| Buprenorphine Hcl | 27 | $22K |
| Hydrocodone/Acetaminophen | 449 | $19K |
| Fentanyl | 139 | $19K |
| Oxycodone Hcl | 576 | $16K |
| Naloxegol Oxalate | 38 | $15K |
| Linaclotide | 26 | $14K |
| Gabapentin | 426 | $12K |
| Buprenorphine | 33 | $12K |
| Morphine Sulfate | 198 | $11K |
Prescribing Profile
52
Unique Drugs
21.0
Anomaly Score
Patient Profile
69
Avg Age
63%
Female
1.48
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