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: 87%
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
522
Total Claims
$98K
Drug Cost
21
Beneficiaries
$4,656
Cost/Patient
Risk Score Breakdown 51/100
Score components are additive. Read full methodology
Peer Comparison vs. 218,535 Nurse Practitioner providers
+1723%
Opioid rate vs peers
69.0% vs 3.8% avg
+296%
Cost per patient vs peers
$4,656 vs $1,174 avg
+10%
Brand preference vs peers
9.8% vs 8.9% avg
⚠️ This provider has metrics more than 3 standard deviations above their specialty average in one or more categories.
🔎 Data Overview
ML fraud detection score of 87% indicates prescribing patterns with significant similarity to confirmed fraud cases. 17 out of 20 decision trees flagged this provider.
Opioid prescribing rate is 1,723% above the average for Nurse Practitioner providers. While some providers legitimately treat pain-heavy populations, deviations of this magnitude are rare and warrant examination.
Composite risk score of 51/100 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
69.0%
Opioid Rate
360
Opioid Claims
$90K
Opioid Cost
52.2%
Long-Acting Rate
This provider's opioid prescribing rate of 69.0% is above the 20% threshold that CMS considers elevated.
Brand vs Generic
Brand: 51 claims · $29K
Generic: 471 claims · $69K
Patient Profile
59
Avg Age
—
Female
1.45
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