High Risk Medicaid Unit - ER Visits, Multiple Doctors & Pharmacies

An OIG investigation determined that a beneficiary utilized the emergency department 14 times within a 10-day period with only two follow-up appointments with a provider. The beneficiary obtained 12 controlled substance prescriptions from seven different providers while using nine different pharmacies to fill the prescriptions. The beneficiary paid cash for a controlled substance prescription covered by Medicaid. Beneficiary Monitoring Program confined the beneficiary to a specified provider for two years, resulting in Medicaid cost avoidance of $19,708.