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Recipient misutilization and abuse - 55 Pa. Code § 1101.91

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Providers must notify the local County Assistance Office if he has reason to believe that a recipient is mis-utilizing or abusing medical assistance services or may be defrauding the medical assistance program.  The department of welfare has established procedures for reviewing recipient utilization of medical assistance services, which identify recipients that are receiving excessive or unnecessary treatment, services or supplies by visiting multiple practitioners.  If the results of the department’s review warrant it, such recipients will be restricted to obtaining certain services from a single provider of his choice.

Current as of June 2015