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: Very High
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
18,062
Total Claims
$1.3M
Drug Cost
582
Beneficiaries
$2,266
Cost/Patient
Risk Score Breakdown 24/100
Score components are additive. Read full methodology
Peer Comparison vs. 7,389 General Practice providers
+473%
Opioid rate vs peers
14.2% vs 2.5% avg
+101%
Cost per patient vs peers
$2,266 vs $1,128 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.
Opioid rate is 473% above General Practice peers. This is a significant deviation that may reflect a specialized patient population or concerning prescribing patterns.
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
14.2%
Opioid Rate
2,562
Opioid Claims
$73K
Opioid Cost
1.3%
Long-Acting Rate
Brand vs Generic
Brand: 1,514 claims · $975K
Generic: 16,445 claims · $340K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Semaglutide | 120 | $133K |
| Apixaban | 85 | $74K |
| Linaclotide | 72 | $52K |
| Fluticasone/Umeclidin/Vilanter | 49 | $45K |
| Empagliflozin | 37 | $44K |
| Rifaximin | 12 | $41K |
| Budesonide/Formoterol Fumarate | 70 | $39K |
| Cariprazine Hcl | 26 | $39K |
| Dapagliflozin Propanediol | 43 | $38K |
| Lipase/Protease/Amylase | 13 | $37K |
| Oxycodone Hcl/Acetaminophen | 1,078 | $37K |
| Insulin Aspart | 32 | $31K |
| Insulin Detemir | 17 | $30K |
| Insulin Glargine,hum.Rec.Anlog | 33 | $29K |
| Hydrocodone/Acetaminophen | 1,147 | $29K |
Prescribing Profile
Patient Profile
68
Avg Age
54%
Female
1.20
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