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
682
Total Claims
$281K
Drug Cost
21
Beneficiaries
$13K
Cost/Patient
Risk Score Breakdown 46/100
Score components are additive. Read full methodology
Peer Comparison vs. 2,743 Pediatric Medicine providers
+2619%
Opioid rate vs peers
43.3% vs 1.6% avg
+538%
Cost per patient vs peers
$13K vs $2,098 avg
-21%
Brand preference vs peers
11.9% vs 15.1% 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 2,619% above the average for Pediatric Medicine providers. While some providers legitimately treat pain-heavy populations, deviations of this magnitude are rare and warrant examination.
Cost per patient is 538% above the specialty average. Extreme cost outliers may indicate prescribing of unnecessarily expensive brand-name drugs or inappropriate drug utilization.
Insights generated from CMS data analysis. Statistical patterns are not accusations — always consider clinical context.
Opioid Prescribing
43.3%
Opioid Rate
295
Opioid Claims
$10K
Opioid Cost
33.6%
Long-Acting Rate
This provider's opioid prescribing rate of 43.3% is above the 20% threshold that CMS considers elevated.
Brand vs Generic
Brand: 81 claims · $210K
Generic: 601 claims · $71K
Patient Profile
38
Avg Age
—
Female
4.86
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