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
11,537
Total Claims
$648K
Drug Cost
1,297
Beneficiaries
$500
Cost/Patient
Risk Score Breakdown 38/100
Score components are additive. Read full methodology
Peer Comparison vs. 7,404 Physical Medicine and Rehabilitation providers
+279%
Opioid rate vs peers
76.5% vs 20.2% avg
+10%
Cost per patient vs peers
$500 vs $455 avg
+37%
Brand preference vs peers
4.3% 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 279% 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
76.5%
Opioid Rate
8,827
Opioid Claims
$483K
Opioid Cost
15.6%
Long-Acting Rate
This provider's opioid prescribing rate of 76.5% is above the 20% threshold that CMS considers elevated.
Brand vs Generic
Brand: 495 claims · $253K
Generic: 11,042 claims · $395K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Hydrocodone/Acetaminophen | 4,600 | $144K |
| Oxycodone Hcl | 85 | $72K |
| Oxycodone Myristate | 69 | $55K |
| Buprenorphine Hcl/Naloxone Hcl | 145 | $35K |
| Fentanyl | 226 | $29K |
| Oxycodone Hcl/Acetaminophen | 912 | $28K |
| Oxycodone Hcl | 962 | $23K |
| Morphine Sulfate | 739 | $23K |
| Buprenorphine Hcl/Naloxone Hcl | 28 | $22K |
| Oxymorphone Hcl | 25 | $21K |
| Buprenorphine Hcl | 21 | $20K |
| Buprenorphine | 67 | $18K |
| Pregabalin | 670 | $16K |
| Tapentadol Hcl | 14 | $15K |
| Gabapentin | 565 | $11K |
Prescribing Profile
39
Unique Drugs
38.0
Anomaly Score
Patient Profile
67
Avg Age
57%
Female
1.87
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