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: 85%
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
16,312
Total Claims
$1.6M
Drug Cost
446
Beneficiaries
$3,477
Cost/Patient
Risk Score Breakdown 26/100
Score components are additive. Read full methodology
Peer Comparison vs. 110,156 Internal Medicine providers
+240%
Opioid rate vs peers
7.6% vs 2.2% avg
+146%
Cost per patient vs peers
$3,477 vs $1,411 avg
+53%
Brand preference vs peers
16.2% vs 10.6% 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
ML fraud detection score of 85% indicates prescribing patterns with significant similarity to confirmed fraud cases. 17 out of 20 decision trees flagged this provider.
Opioid rate is 240% above Internal Medicine peers. This is a significant deviation that may reflect a specialized patient population or concerning prescribing patterns.
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
7.6%
Opioid Rate
1,242
Opioid Claims
$23K
Opioid Cost
—
Long-Acting Rate
Brand vs Generic
Brand: 2,632 claims · $1.2M
Generic: 13,576 claims · $317K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Apixaban | 376 | $155K |
| Fluticasone/Umeclidin/Vilanter | 174 | $128K |
| Empagliflozin | 100 | $92K |
| Dulaglutide | 76 | $76K |
| Linaclotide | 76 | $49K |
| Tirzepatide | 37 | $39K |
| Rivaroxaban | 83 | $36K |
| Dapagliflozin Propanediol | 54 | $36K |
| Cariprazine Hcl | 24 | $36K |
| Sitagliptin Phosphate | 44 | $34K |
| Umeclidinium Brm/Vilanterol Tr | 61 | $31K |
| Eslicarbazepine Acetate | 24 | $31K |
| Budesonide/Glycopyr/Formoterol | 37 | $25K |
| Insulin Glargine,hum.Rec.Anlog | 51 | $25K |
| Fluticasone/Vilanterol | 46 | $22K |
Prescribing Profile
Patient Profile
70
Avg Age
53%
Female
2.52
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 of wrongdoing.Methodology · About · Dispute this data