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 →38
🟠 Elevated
Risk Flags
Risk indicators are statistical patterns, not allegations. Learn more
6,233
Total Claims
$289K
Drug Cost
459
Beneficiaries
$630
Cost/Patient
Risk Score Breakdown 38/100
Score components are additive. Read full methodology
Peer Comparison vs. 7,404 Physical Medicine and Rehabilitation providers
+248%
Opioid rate vs peers
70.2% vs 20.2% avg
+38%
Cost per patient vs peers
$630 vs $455 avg
+9%
Brand preference vs peers
3.4% 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
Opioid rate is 248% above Physical Medicine and Rehabilitation 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
70.2%
Opioid Rate
4,377
Opioid Claims
$202K
Opioid Cost
18.9%
Long-Acting Rate
This provider's opioid prescribing rate of 70.2% is above the 20% threshold that CMS considers elevated.
Brand vs Generic
Brand: 214 claims · $109K
Generic: 6,019 claims · $180K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Hydrocodone/Acetaminophen | 1,788 | $46K |
| Oxycodone Myristate | 49 | $27K |
| Buprenorphine | 74 | $25K |
| Oxycodone Hcl/Acetaminophen | 809 | $25K |
| Buprenorphine Hcl/Naloxone Hcl | 71 | $22K |
| Buprenorphine | 21 | $15K |
| Buprenorphine Hcl | 24 | $13K |
| Pregabalin | 321 | $12K |
| Morphine Sulfate | 517 | $12K |
| Fentanyl | 98 | $9,711 |
| Tapentadol Hcl | 12 | $9,430 |
| Gabapentin | 524 | $8,145 |
| Oxycodone Hcl | 283 | $4,645 |
| Tramadol Hcl | 444 | $3,787 |
| Baclofen | 154 | $2,276 |
Prescribing Profile
25
Unique Drugs
38.0
Anomaly Score
Patient Profile
70
Avg Age
66%
Female
1.81
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