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: 90%
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
25,916
Total Claims
$1.3M
Drug Cost
317
Beneficiaries
$3,993
Cost/Patient
Risk Score Breakdown 36/100
Score components are additive. Read full methodology
Peer Comparison vs. 16,767 Hospitalist providers
-61%
Opioid rate vs peers
1.2% vs 3.0% avg
+835%
Cost per patient vs peers
$3,993 vs $427 avg
+137%
Brand preference vs peers
12.4% vs 5.2% 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
ML fraud detection score of 90% indicates prescribing patterns with significant similarity to confirmed fraud cases. 18 out of 20 decision trees flagged this provider.
Cost per patient is 835% 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
1.2%
Opioid Rate
306
Opioid Claims
$16K
Opioid Cost
14.1%
Long-Acting Rate
Brand vs Generic
Brand: 3,198 claims · $939K
Generic: 22,549 claims · $314K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Apixaban | 1,013 | $226K |
| Insulin Aspart | 135 | $70K |
| Rivaroxaban | 119 | $37K |
| Pimavanserin Tartrate | 16 | $36K |
| Insulin Aspart | 76 | $35K |
| Rifaximin | 22 | $34K |
| Mirabegron | 231 | $33K |
| Semaglutide | 33 | $32K |
| Fluticasone/Umeclidin/Vilanter | 38 | $29K |
| Dulaglutide | 23 | $22K |
| Sitagliptin Phosphate | 65 | $20K |
| Insulin Glargine,hum.Rec.Anlog | 74 | $19K |
| Linagliptin | 59 | $18K |
| Empagliflozin | 51 | $18K |
| Umeclidinium Brm/Vilanterol Tr | 49 | $18K |
Prescribing Profile
Patient Profile
74
Avg Age
62%
Female
2.35
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