Missouri Medicaid Audit and Compliance (MMAC) has seen a recent increase in fraudulent prescriptions passed across Missouri. The prescriptions contain similarities, listed below, and illustrated in a sample template.
(click here to view the template)
Common characteristics of the fraudulent prescriptions:
- St. Louis area prescribers
- Prescriptions are usually written for Oxycodone-Acetaminophen 10-325 for quantities of 120-180 tablets
- Patient addresses are invalid. The invalid street addresses are usually in the same city as the pharmacy where the prescriptions are presented
- Prescriptions usually presented to the pharmacy after the doctors’ offices have closed
- Some were presented on tamper-resistant paper.
Unless an exception exists, MO HealthNet prescriptions must be written on tamper-resistant paper. (Exceptions include prescriptions reimbursed by a MO HealthNet managed care entity, prescriptions provided in certain facilities such as nursing facilities and hospitals, and prescriptions faxed, telephoned, or e-prescribed.) As a reminder, to be compliant with this requirement, a prescription pad must contain the following characteristics:
- An industry-recognized feature designed to prevent unauthorized copying of a completed or blank prescription form (such as a high security watermark on the reverse of the blank or the use of thermochromic ink)
- An industry-recognized feature designed to prevent erasure or modification of information written on the prescription by the prescriber (such as tamper-resistant background ink that shows erasures or attempts to change written information)
- An industry-recognized feature designed to prevent the use of counterfeit prescription forms (such as sequentially numbered blanks or duplicate or triplicate blanks)As noted above, some of the fraudulent prescriptions were presented on tamper-resistant paper, , highlighting the need to check for all three required features.If you suspect prescription fraud regarding a Medicaid participant, please contact MMAC.LOCKIN@dss.mo.gov or call (573) 751-3399). As well, if you suspect any person is breaking the law in your pharmacy, contact local law enforcement.
If you have any questions, please contact MMAC at MMAC.REPORTFRAUD@dss.mo.gov