Medicare Part D Payments
$128.2B
Annual payments to plans
Excess Costs Quantified
$1.22B
95% CI: $1.21 to $1.24 billion
High Risk Prescribers
51,660
5.0% of 1.03M analyzed
Part D Improper Payments
$3.58B
3.70% annual rate (CMS data)
Method Concordance
61.6%
ML and statistical agreement
Peer Groups Created
2,020
196 specialties × 61 jurisdictions
Top 5 States by Excess Medicare Costs
Validation Performance Metrics
Risk Score Distribution
Geographic Anomaly Rates
System Performance Metrics
| Metric |
Value |
Significance |
| Total Prescribers Analyzed |
1.38 million |
Complete Medicare Part D population |
| Final Analysis Set |
1,033,188 |
74.8% retention after filtering |
| Processing Time |
47.3 seconds |
Real time analysis capability |
| Peer Groups Established |
2,020 |
Specialty state combinations |
| Medical Specialties |
196 |
Complete specialty coverage |
| U.S. Jurisdictions |
61 |
All states and territories |
| Clinical Exclusions |
7,701 |
Oncology and palliative care excluded |
| Random Seed |
42 |
Fixed for reproducibility |
Validation Results
| Validation Method |
Result |
Interpretation |
| Method Concordance |
61.6% |
ML and statistical methods reach similar conclusions |
| Bootstrap Stability |
2.3% std error |
100 iterations, high statistical confidence |
| Subsample Correlation |
98.7% |
Random 10% samples produce consistent findings |
| CMS Audit Alignment |
72% |
Consistency with prior manual Medicare reviews |
| Temporal Persistence |
63% (projected) |
High risk patterns expected to persist across years |
Geographic Distribution (Top 5 States)
| State |
Prescribers |
Anomalies |
Rate |
Excess Cost |
| Florida |
52,847 |
2,470 |
4.67% |
$101.8M |
| California |
89,234 |
4,327 |
4.85% |
$80.2M |
| Texas |
45,623 |
2,208 |
4.84% |
$69.7M |
| North Carolina |
28,456 |
2,063 |
7.25% |
$56.3M |
| Georgia |
22,789 |
1,102 |
4.83% |
$49.5M |
Important Note: This system identifies statistical anomalies warranting further investigation, not confirmed fraud or abuse. As the Centers for Medicare & Medicaid Services notes, not all improper payments represent fraud or abuse. Actual recoverable amounts depend on subsequent investigation and enforcement capacity.