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 →🚫 This provider appears on the OIG List of Excluded Individuals/Entities (LEIE)
Exclusion type: 1128a2 · Date: 11/20/2024 · State: CO
Risk Flags
Risk indicators are statistical patterns, not allegations. Learn more
41
Total Claims
$3,699
Drug Cost
16
Beneficiaries
$231
Cost/Patient
🔎 Data Overview
This provider appears on the federal OIG exclusion list, meaning they have been formally barred from participating in federal healthcare programs due to fraud, patient abuse, licensing issues, or other misconduct. The fact that they still appear in active prescribing data is a significant concern.
Prescribes only 2 unique drugs with a 31.7% opioid rate. Very low drug diversity combined with high opioid prescribing is a classic statistical marker of potential pill mill operations. However, some legitimate practices (e.g., addiction treatment with buprenorphine) can show similar patterns.
Composite risk score of 100/100 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
31.7%
Opioid Rate
13
Opioid Claims
$81
Opioid Cost
—
Long-Acting Rate
This provider's opioid prescribing rate of 31.7% is above the 20% threshold that CMS considers elevated.
Brand vs Generic
Brand: 0 claims · $0
Generic: 40 claims · $257
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Cephalexin | 15 | $138 |
| Oxycodone Hcl/Acetaminophen | 12 | $77 |
Prescribing Profile
2
Unique Drugs
Patient Profile
69
Avg Age
—
Female
1.18
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