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 →Risk Flags
Risk indicators are statistical patterns, not allegations. Learn more
3,055
Total Claims
$488K
Drug Cost
300
Beneficiaries
$1,626
Cost/Patient
Risk Score Breakdown 50/100
Score components are additive. Read full methodology
Peer Comparison vs. 988 Specialist providers
+1317%
Opioid rate vs peers
71.2% vs 5.0% avg
+90%
Cost per patient vs peers
$1,626 vs $856 avg
+34%
Brand preference vs peers
11.0% vs 8.2% avg
⚠️ This provider has metrics more than 3 standard deviations above their specialty average in one or more categories.
🔎 Data Overview
Opioid prescribing rate is 1,317% above the average for Specialist providers. While some providers legitimately treat pain-heavy populations, deviations of this magnitude are rare and warrant examination.
Composite risk score of 50/100 places this provider in the "High Risk" category — the top 0.017% of all Medicare Part D prescribers. Multiple independent risk factors are contributing simultaneously.
Insights generated from CMS data analysis. Statistical patterns are not accusations — always consider clinical context.
Opioid Prescribing
71.2%
Opioid Rate
2,176
Opioid Claims
$451K
Opioid Cost
33.6%
Long-Acting Rate
This provider's opioid prescribing rate of 71.2% is above the 20% threshold that CMS considers elevated.
Brand vs Generic
Brand: 336 claims · $344K
Generic: 2,719 claims · $144K
Patient Profile
62
Avg Age
53%
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