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: 1128a4 · Date: 08/20/2024 · State: WV
Risk Flags
Risk indicators are statistical patterns, not allegations. Learn more
492
Total Claims
$145K
Drug Cost
32
Beneficiaries
$4,538
Cost/Patient
Risk Score Breakdown 58/100
Score components are additive. Read full methodology
Peer Comparison vs. 110,156 Internal Medicine providers
+1770%
Opioid rate vs peers
41.9% vs 2.2% avg
+222%
Cost per patient vs peers
$4,538 vs $1,411 avg
+45%
Brand preference vs peers
15.4% vs 10.6% avg
⚠️ This provider has metrics more than 3 standard deviations above their specialty average in one or more categories.
🔎 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 1,770% above the average for Internal Medicine providers. While some providers legitimately treat pain-heavy populations, deviations of this magnitude are rare and warrant examination.
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
41.9%
Opioid Rate
206
Opioid Claims
$137K
Opioid Cost
50.0%
Long-Acting Rate
This provider's opioid prescribing rate of 41.9% is above the 20% threshold that CMS considers elevated.
Brand vs Generic
Brand: 76 claims · $119K
Generic: 416 claims · $26K
Patient Profile
62
Avg Age
50%
Female
1.04
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