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
15,473
Total Claims
$1.2M
Drug Cost
619
Beneficiaries
$1,956
Cost/Patient
Risk Score Breakdown 24/100
Score components are additive. Read full methodology
Peer Comparison vs. 110,156 Internal Medicine providers
+249%
Opioid rate vs peers
7.8% vs 2.2% avg
+39%
Cost per patient vs peers
$1,956 vs $1,411 avg
+8%
Brand preference vs peers
11.4% 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
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.
Opioid rate is 249% 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
7.8%
Opioid Rate
1,210
Opioid Claims
$44K
Opioid Cost
5.2%
Long-Acting Rate
Brand vs Generic
Brand: 1,761 claims · $843K
Generic: 13,620 claims · $364K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Semaglutide | 92 | $100K |
| Rivaroxaban | 76 | $62K |
| Fluticasone/Umeclidin/Vilanter | 67 | $50K |
| Dapagliflozin Propanediol | 54 | $46K |
| Apixaban | 48 | $46K |
| Insulin Degludec | 40 | $38K |
| Lipase/Protease/Amylase | 15 | $35K |
| Empagliflozin | 43 | $35K |
| Insulin Glargine,hum.Rec.Anlog | 50 | $29K |
| Sitagliptin Phos/Metformin Hcl | 38 | $27K |
| Mirabegron | 43 | $24K |
| Sitagliptin Phosphate | 27 | $21K |
| Fluticasone/Vilanterol | 43 | $21K |
| Vortioxetine Hydrobromide | 36 | $20K |
| Cariprazine Hcl | 13 | $19K |
Prescribing Profile
Patient Profile
74
Avg Age
56%
Female
1.08
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