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: 1128(b)(4) — License Revocation/Suspension · Date: 06/19/2025 · State: CA
Risk Flags
Risk indicators are statistical patterns, not allegations. Learn more
226
Total Claims
$75K
Drug Cost
15
Beneficiaries
$5,025
Cost/Patient
Risk Score Breakdown 77/100
Score components are additive. Read full methodology
Peer Comparison vs. 110,156 Internal Medicine providers
+2687%
Opioid rate vs peers
62.4% vs 2.2% avg
+256%
Cost per patient vs peers
$5,025 vs $1,411 avg
+225%
Brand preference vs peers
34.5% vs 10.6% avg
⚠️ This provider has metrics more than 3 standard deviations above their specialty average in one or more categories.
⚠️ 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
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.
Opioid prescribing rate is 2,687% 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.
Prescribes only 6 unique drugs, which is unusually low. Most providers prescribe 30+ different medications. Narrow prescribing patterns deserve context about the provider's practice scope.
Composite risk score of 77/100 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
62.4%
Opioid Rate
141
Opioid Claims
$67K
Opioid Cost
35.5%
Long-Acting Rate
This provider's opioid prescribing rate of 62.4% is above the 20% threshold that CMS considers elevated.
Brand vs Generic
Brand: 78 claims · $65K
Generic: 148 claims · $10K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Oxycodone Hcl | 47 | $64K |
| Oxycodone Hcl | 40 | $1,842 |
| Hydrocodone/Acetaminophen | 26 | $698 |
| Hydromorphone Hcl | 21 | $326 |
| Gabapentin | 12 | $117 |
| Alprazolam | 17 | $76 |
| Diazepam | 31 | $75 |
Prescribing Profile
6
Unique Drugs
77.0
Anomaly Score
Patient Profile
71
Avg Age
—
Female
0.75
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