Group Practice Pattern Score Methodology
Pattern scores summarize statistical patterns in public CMS and OIG datasets for group practices sharing a Group Practice PAC ID (Org_PAC_ID). They are informational only.
Data limitations
- Only clinicians present in the CMS Doctors & Clinicians file appear.
- One database row per NPI — multiple CMS practice locations may collapse to the last imported row.
- No historical snapshots in v1 — group membership churn over time is not measured yet.
- Pattern score is not fraud detection or a compliance verdict.
Signal weights (v1)
- +25 LEIE match in group (OIG public file, NPI match)
- +20 PECOS participating below 70% of members
- +15 Members in 3+ states
- +10 More than 40% of members without hospital affiliation in CMS data
- +10 Shared CMS-reported practice phone (3+ members)
- +5 to +15 Large group size tier (informational)
Total score is capped at 100. Tiers: 0–24 standard, 25–49 elevated, 50+ multiple elevated patterns.
Primary data sources
- CMS Doctors & Clinicians — data.cms.gov
- CMS PECOS PPEF enrollment extract
- OIG LEIE public exclusion file
- CMS Facility Affiliation (hospital links)
- NPPES provider registry (member profiles)
Legal & compliance notice
- Scores and signals are informational statistical indicators only.
- They do not establish fraud, misconduct, or legal liability.
- No medical, legal, or compliance advice is provided.
- Confirm current status on official CMS and OIG sources before decisions.