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: 95%
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
10,004
Total Claims
$1.0M
Drug Cost
369
Beneficiaries
$2,840
Cost/Patient
Risk Score Breakdown 24/100
Score components are additive. Read full methodology
Peer Comparison vs. 110,156 Internal Medicine providers
+610%
Opioid rate vs peers
15.9% vs 2.2% avg
+101%
Cost per patient vs peers
$2,840 vs $1,411 avg
+9%
Brand preference vs peers
11.6% 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 prescribing rate is 610% above the average for Internal Medicine 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.
Insights generated from CMS data analysis. Statistical patterns are not accusations — always consider clinical context.
Opioid Prescribing
15.9%
Opioid Rate
1,591
Opioid Claims
$51K
Opioid Cost
3.6%
Long-Acting Rate
Brand vs Generic
Brand: 1,141 claims · $807K
Generic: 8,722 claims · $228K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Semaglutide | 106 | $141K |
| Linaclotide | 70 | $55K |
| Apixaban | 48 | $53K |
| Sarilumab | 11 | $49K |
| Bictegrav/Emtricit/Tenofov Ala | 11 | $46K |
| Fluticasone/Umeclidin/Vilanter | 47 | $43K |
| Insulin Aspart | 22 | $25K |
| Mirabegron | 33 | $21K |
| Insulin Aspart Prot/Insuln Asp | 13 | $21K |
| Ipratropium/Albuterol Sulfate | 26 | $20K |
| Sitagliptin Phos/Metformin Hcl | 12 | $19K |
| Dulaglutide | 18 | $18K |
| Metformin Hcl | 13 | $17K |
| Hydrocodone/Acetaminophen | 638 | $17K |
| Pitavastatin Calcium | 20 | $12K |
Prescribing Profile
Patient Profile
71
Avg Age
56%
Female
1.18
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