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Data Sources: Centers for Medicare & Medicaid Services (CMS), Medicare Provider Utilization and Payment Data
Disclaimer: This site is an independent journalism project. Data analysis and editorial content are not affiliated with or endorsed by CMS or any government agency. All spending figures are based on publicly available Medicare payment records.
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Methodology•Download Data
  1. Home
  2. Specialties
  3. Pharmacy
  4. Fraud Risk

Medicare Fraud Risk in Pharmacy

24 flagged Pharmacy providers identified through statistical anomaly detection.

Share:

Flagged Providers

24

of 12.8K total

Average Risk Score

72/100

Specialty Markup

1.7x

Total Payments

$1.2B

Most Common Fraud Flags

Types of billing anomalies most frequently detected among flagged Pharmacy providers.

💰 Outlier Spending24 providers
👥 Beneficiary Stuffing24 providers
📊 Volume Anomaly24 providers
📈 High Markup6 providers

Top Flagged Pharmacy Providers

ProviderLocationRisk ScoreTotal PaymentsMarkupFlags
Pentec Health IncUpper Chichester, PA80$4.4M6.5xoutlier spending, high markup
Cost Less Senior Services IncGig Harbor, WA78$663.6K1539.8xoutlier spending, high markup
All Family Pharmacy LlcBoca Raton, FL75$30.5M1.0xoutlier spending, beneficiary stuffing
J's Pharmacy LlcWilsonville, AL75$28.8M1.0xoutlier spending, beneficiary stuffing
Vra Enterprises, LlcTampa, FL75$26.6M1.0xoutlier spending, beneficiary stuffing
Tru Script Pharmacy LlcTulsa, OK75$26.0M1.0xoutlier spending, beneficiary stuffing
Ez Rx Boynton Beach LlcBoca Raton, FL75$23.1M1.0xoutlier spending, beneficiary stuffing
Meds To You LlcIndianapolis, IN75$16.8M1.0xoutlier spending, beneficiary stuffing
Staywell Pharmacy CorpPalatine, IL75$2.1M3.6xoutlier spending, high markup
Aaa Gpo IncValley Stream, NY74$13.4M2.5xoutlier spending, beneficiary stuffing
Medsbyme LlcMount Vernon, NY74$13.1M1.0xoutlier spending, beneficiary stuffing
Trifecta Pharmacy LlcThe Woodlands, TX71$7.9M1.0xoutlier spending, beneficiary stuffing
Freedom Pharmacy And Medical SupplyHouston, TX71$7.0M1.0xoutlier spending, beneficiary stuffing
Groveway Pharmacy, Inc.Humble, TX71$6.7M1.0xoutlier spending, beneficiary stuffing
Pharmaneek IncIndianapolis, IN70$6.2M1.7xoutlier spending, beneficiary stuffing
Link Pharmacy CorpDallas, TX70$361.2K20.6xoutlier spending, high markup
Advanced Bionics, Llc.Valencia, CA69$6.9M3.1xoutlier spending, high markup
Bayshore Health Mart, Inc.Pasadena, TX69$5.3M1.0xoutlier spending, beneficiary stuffing
Health Wise Affordable PharmacyWharton, TX69$5.1M1.0xoutlier spending, beneficiary stuffing
Delivrxd LlcTampa, FL68$4.3M1.0xoutlier spending, beneficiary stuffing
North Shore Chemists LlcGreat Neck, NY68$544.2K7.8xoutlier spending, high markup
Burke Family Pharmacy IncPasadena, TX66$3.7M1.0xoutlier spending, beneficiary stuffing
Tri County Pharmacy LlcHumble, TX66$2.9M1.0xoutlier spending, beneficiary stuffing
Aaa Drugs IncRosedale, NY66$2.9M1.3xoutlier spending, beneficiary stuffing

Markup by Specialty

How Pharmacy markup compares to other specialties.

Anesthesiology Assistant
12.2x
Dental Anesthesiology
12.2x
Certified Registered Nurse Anesthetist (CRNA)
9.7x
Anesthesiologist Assistants
9.6x
Anesthesiology
8.8x
CRNA
7.4x
Emergency Medicine
7.1x
Radiation Therapy Center
7.1x
Radiation Therapy
6.1x
Ambulatory Surgical Center
6.1x
Independent Diagnostic Testing Facility (IDTF)
6.1x
Neurosurgery
5.9x
Independent Diagnostic Testing Facility
5.5x
Diagnostic Radiology
5.4x
Interventional Radiology
5.1x

⚠️ Disclaimer: Being flagged does not imply fraud. These providers were identified through statistical analysis of billing patterns that deviate significantly from peers. Unusual billing may have legitimate explanations. This data is provided for transparency and public accountability purposes only.

Data Sources

  • • Centers for Medicare & Medicaid Services (CMS)
  • • Medicare Provider Utilization and Payment Data (2014-2023)
  • • OpenMedicare Statistical Anomaly Detection

Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.