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 →29
🟡 Moderate
ML Fraud Detection Score: 89%
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
6,203
Total Claims
$469K
Drug Cost
315
Beneficiaries
$1,490
Cost/Patient
Risk Score Breakdown 29/100
Score components are additive. Read full methodology
Peer Comparison vs. 7,404 Physical Medicine and Rehabilitation providers
+208%
Opioid rate vs peers
62.3% vs 20.2% avg
+227%
Cost per patient vs peers
$1,490 vs $455 avg
+125%
Brand preference vs peers
7.1% vs 3.1% 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 89% indicates prescribing patterns with significant similarity to confirmed fraud cases. 18 out of 20 decision trees flagged this provider.
Opioid rate is 208% above Physical Medicine and Rehabilitation 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
62.3%
Opioid Rate
3,863
Opioid Claims
$390K
Opioid Cost
29.8%
Long-Acting Rate
This provider's opioid prescribing rate of 62.3% is above the 20% threshold that CMS considers elevated.
Brand vs Generic
Brand: 438 claims · $235K
Generic: 5,765 claims · $234K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Oxycodone Myristate | 116 | $119K |
| Oxycodone Hcl | 135 | $82K |
| Oxycodone Hcl | 1,329 | $43K |
| Hydrocodone/Acetaminophen | 644 | $24K |
| Fentanyl | 181 | $22K |
| Morphine Sulfate | 492 | $17K |
| Oxymorphone Hcl | 15 | $13K |
| Naloxegol Oxalate | 19 | $10K |
| Morphine Sulfate | 177 | $10K |
| Oxycodone Hcl/Acetaminophen | 289 | $9,458 |
| Lidocaine | 50 | $8,975 |
| Gabapentin | 252 | $8,208 |
| Buprenorphine | 22 | $6,559 |
| Methadone Hcl | 175 | $5,618 |
| Tizanidine Hcl | 266 | $5,537 |
Prescribing Profile
48
Unique Drugs
29.0
Anomaly Score
Patient Profile
65
Avg Age
65%
Female
1.71
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