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
18,680
Total Claims
$8.0M
Drug Cost
1,430
Beneficiaries
$5,571
Cost/Patient
Risk Score Breakdown 52/100
Score components are additive. Read full methodology
Peer Comparison vs. 5,101 Rheumatology providers
+784%
Opioid rate vs peers
35.9% vs 4.1% avg
-8%
Cost per patient vs peers
$5,571 vs $6,039 avg
⚠️ This provider has metrics more than 3 standard deviations above their specialty average in one or more categories.
⚠️ 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
Opioid prescribing rate is 784% above the average for Rheumatology providers. While some providers legitimately treat pain-heavy populations, deviations of this magnitude are rare and warrant examination.
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.
Composite risk score of 52/100 places this provider in the "High Risk" category — the top 0.017% of all Medicare Part D prescribers. Multiple independent risk factors are contributing simultaneously.
Insights generated from CMS data analysis. Statistical patterns are not accusations — always consider clinical context.
Opioid Prescribing
35.9%
Opioid Rate
6,702
Opioid Claims
$282K
Opioid Cost
11.4%
Long-Acting Rate
This provider's opioid prescribing rate of 35.9% is above the 20% threshold that CMS considers elevated.
Brand vs Generic
Brand: 0 claims · $0
Generic: 16,496 claims · $506K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Adalimumab | 388 | $3.0M |
| Upadacitinib | 106 | $672K |
| Etanercept | 71 | $526K |
| Etanercept | 58 | $446K |
| Certolizumab Pegol | 57 | $366K |
| Tofacitinib Citrate | 57 | $332K |
| Secukinumab | 40 | $293K |
| Tocilizumab | 60 | $271K |
| Abatacept | 30 | $170K |
| Adalimumab | 21 | $158K |
| Denosumab | 91 | $156K |
| Ixekizumab | 22 | $148K |
| Etanercept | 14 | $108K |
| Secukinumab | 11 | $107K |
| Buprenorphine | 289 | $94K |
Prescribing Profile
Patient Profile
69
Avg Age
81%
Female
1.91
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