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 →26
🟡 Moderate
🤖 ML Fraud Detection Score: 86%
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
118,925
Total Claims
$3.0M
Drug Cost
699
Beneficiaries
$4,255
Cost/Patient
Risk Score Breakdown 26/100
Score components are additive. Read full methodology
Peer Comparison vs. 7,404 Physical Medicine and Rehabilitation providers
-92%
Opioid rate vs peers
1.7% vs 20.2% avg
+834%
Cost per patient vs peers
$4,255 vs $455 avg
+248%
Brand preference vs peers
10.9% vs 3.1% 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 86% indicates prescribing patterns with significant similarity to confirmed fraud cases. 17 out of 20 decision trees flagged this provider.
Cost per patient is 834% 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
1.7%
Opioid Rate
1,969
Opioid Claims
$38K
Opioid Cost
3.7%
Long-Acting Rate
Brand vs Generic
Brand: 12,990 claims · $1.9M
Generic: 105,881 claims · $1.1M
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Apixaban | 2,758 | $393K |
| Dulaglutide | 431 | $206K |
| Sitagliptin Phosphate | 636 | $88K |
| Mirabegron | 719 | $82K |
| Rosuvastatin Calcium | 7,546 | $73K |
| Insulin Detemir | 505 | $72K |
| Insulin Aspart | 499 | $72K |
| Memantine Hcl | 4,125 | $71K |
| Rivaroxaban | 430 | $59K |
| Pimavanserin Tartrate | 44 | $51K |
| Risperidone Microspheres | 61 | $48K |
| Potassium Chloride | 3,814 | $47K |
| Paliperidone Palmitate | 14 | $44K |
| Tiotropium Bromide | 78 | $44K |
| Sacubitril/Valsartan | 273 | $41K |
Prescribing Profile
Patient Profile
79
Avg Age
67%
Female
2.48
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