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
85
Total Claims
$8,309
Drug Cost
34
Beneficiaries
$244
Cost/Patient
Risk Score Breakdown 43/100
Score components are additive. Read full methodology
Peer Comparison vs. 2,743 Pediatric Medicine providers
+4116%
Opioid rate vs peers
67.1% vs 1.6% avg
-88%
Cost per patient vs peers
$244 vs $2,098 avg
+17%
Brand preference vs peers
17.6% 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 4,116% 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
67.1%
Opioid Rate
57
Opioid Claims
$7,553
Opioid Cost
35.1%
Long-Acting Rate
This provider's opioid prescribing rate of 67.1% is above the 20% threshold that CMS considers elevated.
Brand vs Generic
Brand: 15 claims · $4,714
Generic: 70 claims · $3,595
Patient Profile
38
Avg Age
50%
Female
5.52
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