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: 93%
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
18,128
Total Claims
$1.1M
Drug Cost
537
Beneficiaries
$2,012
Cost/Patient
Risk Score Breakdown 31/100
Score components are additive. Read full methodology
Peer Comparison vs. 106,889 Family Practice providers
-42%
Opioid rate vs peers
1.5% vs 2.6% avg
+88%
Cost per patient vs peers
$2,012 vs $1,068 avg
-2%
Brand preference vs peers
8.8% vs 9.0% 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 93% indicates prescribing patterns with significant similarity to confirmed fraud cases. 19 out of 20 decision trees flagged this provider.
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
1.5%
Opioid Rate
270
Opioid Claims
$12K
Opioid Cost
18.5%
Long-Acting Rate
Brand vs Generic
Brand: 1,597 claims · $865K
Generic: 16,482 claims · $213K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Dulaglutide | 124 | $145K |
| Apixaban | 382 | $125K |
| Interferon Beta-1a | 11 | $93K |
| Empagliflozin | 92 | $68K |
| Insulin Aspart | 34 | $30K |
| Rivaroxaban | 27 | $29K |
| Sitagliptin Phosphate | 26 | $28K |
| Linagliptin | 20 | $21K |
| Mirabegron | 116 | $20K |
| Fluticasone/Umeclidin/Vilanter | 24 | $18K |
| Insulin Glargine,hum.Rec.Anlog | 45 | $15K |
| Lipase/Protease/Amylase | 55 | $14K |
| Sitagliptin Phos/Metformin Hcl | 18 | $14K |
| Atorvastatin Calcium | 1,201 | $13K |
| Metoprolol Succinate | 690 | $9,227 |
Prescribing Profile
Patient Profile
75
Avg Age
56%
Female
1.32
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