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: 94%
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
10,798
Total Claims
$4.5M
Drug Cost
154
Beneficiaries
$30K
Cost/Patient
Risk Score Breakdown 26/100
Score components are additive. Read full methodology
Peer Comparison vs. 110,156 Internal Medicine providers
+323%
Opioid rate vs peers
9.5% vs 2.2% avg
+1993%
Cost per patient vs peers
$30K vs $1,411 avg
+121%
Brand preference vs peers
23.5% vs 10.6% 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
ML fraud detection score of 94% indicates prescribing patterns with significant similarity to confirmed fraud cases. 19 out of 20 decision trees flagged this provider.
Opioid rate is 323% above Internal Medicine peers. This is a significant deviation that may reflect a specialized patient population or concerning prescribing patterns.
Cost per patient is 1993% above the specialty average. Extreme cost outliers may indicate prescribing of unnecessarily expensive brand-name drugs or inappropriate drug utilization.
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
9.5%
Opioid Rate
1,022
Opioid Claims
$43K
Opioid Cost
—
Long-Acting Rate
Brand vs Generic
Brand: 2,516 claims · $2.1M
Generic: 8,195 claims · $2.4M
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Zileuton | 352 | $553K |
| Omeprazole/Sodium Bicarbonate | 174 | $309K |
| Clemastine Fumarate | 86 | $261K |
| Ipratropium Bromide | 397 | $215K |
| Crotamiton | 127 | $214K |
| Bictegrav/Emtricit/Tenofov Ala | 50 | $203K |
| Lipase/Protease/Amylase | 97 | $154K |
| Methylnaltrexone Bromide | 56 | $140K |
| Dihydroergotamine Mesylate | 71 | $115K |
| Mupirocin Calcium | 192 | $114K |
| Diclofenac Potassium | 35 | $102K |
| Lubiprostone | 166 | $88K |
| Fluticasone Propion/Salmeterol | 230 | $79K |
| Darunavir/Cob/Emtri/Tenof Alaf | 16 | $78K |
| Fluticasone/Umeclidin/Vilanter | 81 | $74K |
Prescribing Profile
Patient Profile
60
Avg Age
55%
Female
1.39
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