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Limited Program (abuse/overuse of Medicaid health benefits)

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The Limited Program is designed to:

  • Control the inappropriate use of medical services, and 
  • Promote quality of care.

The Limited Program assigns Medicaid recipients to a single primary care provider and/or pharmacy if:

  • The client received duplicative, excessive, or conflicting health care services including drugs, or
  • Review shows abuse, misuse, or suspected fraudulent actions related to Medicaid benefits and services.

Recipients should be referred to the Limited Program for review if there is suspicion of:

  • Excessive use or overuse of Medicaid;
  • Fraudulent activities including but not limited to:
    • Prescription fraud
      • Possessing blank or forged prescription pads;
      • Forging, duplicating or altering a prescription; and/or,
      • Calling in a prescription;
    • Trafficking
      • Selling or trading, or attempting to sell or trade, drugs or supplies acquired through Medicaid;
    • Medicaid identity fraud for the purpose of obtaining unauthorized medical benefits, including:
      • Using another's Medicaid Identification card;
      • Lending, altering or duplicating a Medicaid ID; and/or
      • Providing incorrect eligibility or false information to a vendor to obtain treatment; and/or
    • Knowingly assisting providers in rendering services to defraud the Medicaid Program.

Need to reach the Limited Program section directly? Please call 800-436-6184. You may also reach the Limited Program section by fax, 512-833-6543.

Office of Inspector General
Office of Inspector General P.O. Box 85200 Austin, TX 78708-5200 | ©2006-2007 All rights reserved