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: 88%
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
15,993
Total Claims
$2.3M
Drug Cost
993
Beneficiaries
$2,295
Cost/Patient
Risk Score Breakdown 21/100
Score components are additive. Read full methodology
Peer Comparison vs. 110,156 Internal Medicine providers
+289%
Opioid rate vs peers
8.7% vs 2.2% avg
+63%
Cost per patient vs peers
$2,295 vs $1,411 avg
+22%
Brand preference vs peers
12.9% 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 88% indicates prescribing patterns with significant similarity to confirmed fraud cases. 18 out of 20 decision trees flagged this provider.
Opioid rate is 289% 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
8.7%
Opioid Rate
1,394
Opioid Claims
$45K
Opioid Cost
—
Long-Acting Rate
Brand vs Generic
Brand: 2,045 claims · $2.0M
Generic: 13,747 claims · $291K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Semaglutide | 234 | $312K |
| Dulaglutide | 101 | $155K |
| Empagliflozin | 111 | $134K |
| Dapagliflozin Propanediol | 152 | $117K |
| Apremilast | 16 | $78K |
| Tirzepatide | 42 | $65K |
| Semaglutide | 32 | $59K |
| Rivaroxaban | 62 | $58K |
| Apixaban | 83 | $57K |
| Sitagliptin Phosphate | 54 | $53K |
| Insulin Glargine,hum.Rec.Anlog | 55 | $50K |
| Exenatide Microspheres | 27 | $48K |
| Insulin Glargine,hum.Rec.Anlog | 34 | $48K |
| Mirabegron | 68 | $48K |
| Hydrocodone/Acetaminophen | 1,009 | $39K |
Prescribing Profile
Patient Profile
69
Avg Age
60%
Female
1.92
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