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: 86%
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
420
Total Claims
$170K
Drug Cost
24
Beneficiaries
$7,065
Cost/Patient
Risk Score Breakdown 46/100
Score components are additive. Read full methodology
Peer Comparison vs. 2,743 Pediatric Medicine providers
+3702%
Opioid rate vs peers
60.5% vs 1.6% avg
+237%
Cost per patient vs peers
$7,065 vs $2,098 avg
+4%
Brand preference vs peers
15.7% vs 15.1% avg
⚠️ This provider has metrics more than 3 standard deviations above their specialty average in one or more categories.
🔎 Data Overview
ML fraud detection score of 86% indicates prescribing patterns with significant similarity to confirmed fraud cases. 17 out of 20 decision trees flagged this provider.
Opioid prescribing rate is 3,702% above the average for Pediatric Medicine providers. While some providers legitimately treat pain-heavy populations, deviations of this magnitude are rare and warrant examination.
Insights generated from CMS data analysis. Statistical patterns are not accusations — always consider clinical context.
Opioid Prescribing
60.5%
Opioid Rate
254
Opioid Claims
$118K
Opioid Cost
28.3%
Long-Acting Rate
This provider's opioid prescribing rate of 60.5% is above the 20% threshold that CMS considers elevated.
Brand vs Generic
Brand: 66 claims · $143K
Generic: 354 claims · $27K
Patient Profile
65
Avg Age
54%
Female
2.15
Avg Risk Score
Explore More
Data from CMS Medicare Part D Prescriber Public Use File, 2023. Risk scores are statistical indicators, not allegations.Methodology · About