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: 96%
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
953
Total Claims
$55K
Drug Cost
184
Beneficiaries
$298
Cost/Patient
Risk Score Breakdown 18/100
Score components are additive. Read full methodology
Peer Comparison vs. 2,621 Pain Management providers
+47%
Opioid rate vs peers
60.8% vs 41.3% avg
-25%
Cost per patient vs peers
$298 vs $399 avg
+37%
Brand preference vs peers
5.1% vs 3.8% 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
Our machine learning model — trained on 281 confirmed fraud cases — gives this provider a "Very High" fraud-pattern score. All 20 decision trees in our ensemble model agree that this provider's prescribing patterns resemble those of confirmed fraud cases. This is a statistical finding, not an accusation.
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
60.8%
Opioid Rate
579
Opioid Claims
$44K
Opioid Cost
21.6%
Long-Acting Rate
This provider's opioid prescribing rate of 60.8% is above the 20% threshold that CMS considers elevated.
Brand vs Generic
Brand: 49 claims · $30K
Generic: 904 claims · $25K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Oxycodone Hcl | 39 | $26K |
| Hydrocodone/Acetaminophen | 272 | $7,545 |
| Fentanyl | 28 | $4,861 |
| Pregabalin | 38 | $2,812 |
| Gabapentin | 129 | $2,248 |
| Oxycodone Hcl | 46 | $1,230 |
| Morphine Sulfate | 52 | $1,192 |
| Tizanidine Hcl | 38 | $682 |
| Oxycodone Hcl/Acetaminophen | 35 | $571 |
| Methocarbamol | 32 | $482 |
| Acetaminophen With Codeine | 22 | $396 |
| Tramadol Hcl | 53 | $388 |
| Baclofen | 11 | $299 |
| Diclofenac Sodium | 11 | $271 |
| Morphine Sulfate | 11 | $178 |
Prescribing Profile
16
Unique Drugs
18.0
Anomaly Score
Patient Profile
70
Avg Age
63%
Female
1.46
Avg Risk Score
Explore More
Data from CMS Medicare Part D Prescriber Public Use File, 2023. Risk scores are statistical indicators, not allegations of wrongdoing.Methodology · About · Dispute this data