A pill millÓ operates when physicians, clinic owners, & pharmacists collect to defraud Medicaid by prescribing & distributing drugs mainly to obtain reimbursement. Patients are often knowing participants in these schemes, allowing use of their Medicaid recipient numbers for billing purposes in exchange for cash, drugs, or other inducements. This report assesses the extent of the drug diversion problem, the reasons it persists, & what actions are being taken to bring it under control. Charts & tables.

Assesses the extent of the drug diversion problem, the reason it persists, & what actions are being taken to bring it under control. Compares the incidence & outcomes of malpractice litigation involving Medicare & Medicaid patients to that of the general population & analyzes aggregate hospital data on malpractice losses for Medicare, Medicaid, & other hospital patients. Assesses the methods being used to approve or deny Medicare Part B claims. Describes the characteristics of claims denials that are appealed & of those that are reversed. Illustrated.

Distributed to some depository libraries in microfiche.

Inappropriate use of prescription drugs can cause adverse reactions. States have established programs to review Medicaid prescriptions before drugs are dispensed to prevent these reactions. Most states have implemented automated prospective drug utilization (PRODUR) systems. This report examines states' experiences in using automated PRODUR systems & focuses on how such systems can improve patient safety by identifying & preventing inappropriate drug therapy, reduce program costs, & reduce the incidence of fraud, waste, & abuse.

Distributed to some depository libraries in microfiche.