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: 88%
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
1,049
Total Claims
$1.4M
Drug Cost
112
Beneficiaries
$12K
Cost/Patient
Risk Score Breakdown 58/100
Score components are additive. Read full methodology
Peer Comparison vs. 8,541 Hematology-Oncology providers
+1189%
Opioid rate vs peers
80.8% vs 6.3% avg
-10%
Cost per patient vs peers
$12K vs $14K avg
-9%
Brand preference vs peers
13.3% vs 14.6% 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
ML fraud detection score of 88% indicates prescribing patterns with significant similarity to confirmed fraud cases. 18 out of 20 decision trees flagged this provider.
Opioid prescribing rate is 1,189% above the average for Hematology-Oncology 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 10 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 58/100 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
80.8%
Opioid Rate
848
Opioid Claims
$74K
Opioid Cost
40.7%
Long-Acting Rate
This provider's opioid prescribing rate of 80.8% is above the 20% threshold that CMS considers elevated.
Brand vs Generic
Brand: 139 claims · $775K
Generic: 910 claims · $592K
Top Prescribed Drugs
| Drug (Generic) | Claims | Cost |
|---|---|---|
| Lenalidomide | 43 | $537K |
| Pomalidomide | 34 | $403K |
| Oxycodone Hcl | 37 | $35K |
| Oxycodone Myristate | 20 | $12K |
| Morphine Sulfate | 238 | $11K |
| Oxycodone Hcl | 282 | $6,579 |
| Hydrocodone/Acetaminophen | 147 | $3,708 |
| Fentanyl | 13 | $2,028 |
| Morphine Sulfate | 47 | $1,886 |
| Methadone Hcl | 36 | $803 |
| Oxycodone Hcl/Acetaminophen | 17 | $506 |
| Clonazepam | 28 | $151 |
Prescribing Profile
10
Unique Drugs
58.0
Anomaly Score
Patient Profile
52
Avg Age
60%
Female
3.77
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