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: 95%
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
22,010
Total Claims
$3.2M
Drug Cost
1,210
Beneficiaries
$2,660
Cost/Patient
Risk Score Breakdown 41/100
Score components are additive. Read full methodology
Peer Comparison vs. 106,889 Family Practice providers
+642%
Opioid rate vs peers
19.1% vs 2.6% avg
+149%
Cost per patient vs peers
$2,660 vs $1,068 avg
+50%
Brand preference vs peers
13.5% vs 9.0% 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
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 prescribing rate is 642% above the average for Family Practice providers. While some providers legitimately treat pain-heavy populations, deviations of this magnitude are rare and warrant examination.
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
19.1%
Opioid Rate
4,209
Opioid Claims
$107K
Opioid Cost
4.0%
Long-Acting Rate
Brand vs Generic
Brand: 2,955 claims · $2.8M
Generic: 18,933 claims · $400K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Semaglutide | 220 | $365K |
| Tirzepatide | 211 | $274K |
| Fluticasone/Umeclidin/Vilanter | 176 | $209K |
| Dulaglutide | 101 | $168K |
| Dapagliflozin Propanediol | 120 | $148K |
| Linaclotide | 135 | $132K |
| Vortioxetine Hydrobromide | 106 | $108K |
| Cariprazine Hcl | 60 | $101K |
| Rivaroxaban | 85 | $97K |
| Empagliflozin | 68 | $93K |
| Apixaban | 62 | $83K |
| Budesonide/Glycopyr/Formoterol | 74 | $70K |
| Vibegron | 58 | $66K |
| Sacubitril/Valsartan | 40 | $62K |
| Sitagliptin Phos/Metformin Hcl | 39 | $50K |
Prescribing Profile
Patient Profile
68
Avg Age
57%
Female
1.66
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