Medicaid Prescription Drug Diversion: A Major Problem, but State Approaches Offer Some Promise

GAO discussed Medicaid prescription drug diversion, focusing on: (1) the extent of the problem; and (2) New York's initiatives against drug diversion. GAO noted that: (1) prescription drug diversion is a prevalent type of Medicaid fraud; (2) providers and recipients of diverted drugs can be identified, but Medicaid losses are seldom recovered, and punishing offenders is difficult; (3) provider enrollment procedures and ownership data are not sufficient to prevent fraudulent providers from continuing to bill Medicaid; and (4) New York's efforts to reduce drug diversion include timely information gathering on services to recipients, identification of suspicious activity, stricter provider enrollment procedures, and stronger financial recovery and prosecution measures.