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 →21
🟡 Moderate
ML Fraud Detection Score: 91%
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
5,481
Total Claims
$295K
Drug Cost
403
Beneficiaries
$733
Cost/Patient
Risk Score Breakdown 21/100
Score components are additive. Read full methodology
Peer Comparison vs. 1,498 Interventional Pain Management providers
+25%
Opioid rate vs peers
57.5% vs 45.9% avg
+52%
Cost per patient vs peers
$733 vs $483 avg
+39%
Brand preference vs peers
5.7% vs 4.1% 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 91% indicates prescribing patterns with significant similarity to confirmed fraud cases. 18 out of 20 decision trees flagged this provider.
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
57.5%
Opioid Rate
3,154
Opioid Claims
$234K
Opioid Cost
23.9%
Long-Acting Rate
This provider's opioid prescribing rate of 57.5% is above the 20% threshold that CMS considers elevated.
Brand vs Generic
Brand: 315 claims · $173K
Generic: 5,166 claims · $122K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Oxycodone Myristate | 110 | $101K |
| Hydrocodone/Acetaminophen | 1,240 | $27K |
| Oxycodone Hcl/Acetaminophen | 785 | $24K |
| Tapentadol Hcl | 29 | $24K |
| Buprenorphine | 69 | $23K |
| Gabapentin | 753 | $12K |
| Buprenorphine Hcl/Naloxone Hcl | 43 | $7,742 |
| Pregabalin | 227 | $6,975 |
| Methadone Hcl | 388 | $6,402 |
| Oxycodone Hcl | 13 | $6,116 |
| Morphine Sulfate | 165 | $4,572 |
| Morphine Sulfate | 145 | $3,194 |
| Baclofen | 91 | $3,040 |
| Duloxetine Hcl | 190 | $2,476 |
| Tizanidine Hcl | 176 | $2,005 |
Prescribing Profile
30
Unique Drugs
21.0
Anomaly Score
Patient Profile
66
Avg Age
62%
Female
1.89
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