DEPARTMENT OF HEALTH &. HUMAN SERVICES  Office of Inspector General 
Washington, D.C.  20201 
JUL  2 5 2007 
TO:  Herb Kuhn 
Acting Deputy Administrator 
Centers for Medicare & Medicaid Services 
FROM:  Daniel R. Levinson 
Inspector General 
SUBJECT:  Memorandum Report:  "Louisiana Medicaid Payments and Services Related to 
Hurricanes Katrina and Rita:  Data Compendium," OEI-05-07-00300 
This memorandum report is a data compendium of State-specific information on Medicaid 
payments and services in Louisiana for its hurricane-related activities.  It provides both 
descriptive and comparative statistics for Louisiana Medicaid payments and services to 
affected and nonaffected individuals for outpatient and other physician services (referred to as 
medical services) and prescription drugs. 
After Hurricanes Katrina and Rita struck, the Secretary (the Secretary) of the Department of 
Health and Human Services (HHS) approved 32 hurricane-related demonstration projects. 
A companion memorandum report, "Medicaid Payments and Services Related to Hurricanes 
Katrina and Rita" (OEI-05-06-00140), provides an initial, aggregate-level analysis of medical 
services and prescription drugs for eight States in the first two quarters of fiscal year 
(FY) 2006.  Of the eight States reviewed in the companion memorandum report, Louisiana 
accounted for over 95 percent of evacuee expenditures and over 90 percent of evacuees who 
received services. 
Background 
In August and September 2005, the Gulf States were struck by two significant hurricanes. 
Responding to the need for immediate health care in the wake of these hurricanes, the 
Secretary began granting Medicaid waiver and expenditure authorities, allowed under Section 
1115 demonstration projects,  to ensure the delivery of health care services to evacuees and 
I 
affected individuals.  In total, the Secretary approved hurricane-related demonstration projects 
for 30 States, Washington, DC, and Puerto Rico (hereinafter referred to collectively as States). 
Section 1115 demonstration projects have been used in the past following national disasters. 
For example, after the September 11,2001, terrorist attacks, the State of New York requested 
and received approval for a Medicaid Section 1115 demonstration project known as Disaster 
Relief Medicaid.  This demonstration project allowed New York to develop a program 
I Social Security Act,  Il15.  Page 2  Herb Kuhn 
responsive to the emergency situation by allowing self-attestation of income, on-the-spot 
approval, and a temporary eligibility period.2 
However, New Yorks Disaster Relief Medicaid was not without vulnerabilities.  A 
December 2005 report prepared for the New York State Department of Health identified 
patterns of suspect Medicaid utilization in Disaster Relief Medicaid as possible causes of 
concern. Because the 32 hurricane-related demonstration projects, like the New York Disaster 
Relief Medicaid program, waive measures meant to protect the Medicaid program from 
potential fraud and abuse, the potential for similar suspect Medicaid utilization also exists.  
This extensive, almost nationwide waiving of Medicaid requirements heightened concerns that 
fraud or abuse may have occurred. 
To address these concerns, the HHS Office of Inspector General (OIG) issued two 
memorandum reports.  The primary report, Medicaid Payments and Services Related to 
Hurricanes Katrina and Rita (OEI-05-06-00140), describes Medicaid payments made to and 
services provided for outpatient and other physician services (hereinafter referred to 
collectively as medical services) as well as for prescription drugs by eight States that were 
approved for hurricane-related demonstration projects.3  The report provides an initial, 
aggregate-level analysis of data from the first two quarters of FY 2006, which represent the 
first two full fiscal quarters after the hurricanes.  It also provides basic comparisons of the 
evacuee Medicaid population to the nonevacuee Medicaid population. 
This companion report is a data compendium of State-specific information on Medicaid 
payments and services in Louisiana for its hurricane-related activities.  Of the eight States 
reviewed, Louisiana accounted for over 95 percent of evacuee expenditures and over  
90 percent of evacuees who received services.   
Hurricane-Related Demonstration Projects and Activities 
The hurricane-related demonstration projects were intended to assist States in providing 
Medicaid services to evacuees. The Centers for Medicare & Medicaid Services (CMS) defined 
an evacuee in the terms and conditions of the Section 1115 hurricane-related demonstration 
projects as an individual who is a resident of the emergency area affected by a National 
Disaster as declared by the President . . . and has been displaced from his or her home by the 
emergency, and is not a non-qualified alien. . . .4  The Deficit Reduction Act of 2005 
2 Maria Calicchia, et al., Cornell University, School of Industrial and Labor Relations.  Disaster Relief Medicaid 
Evaluation Project, December 2005.  Available online at 
http://www.nyhealth.gov/health_care/medicaid/related/docs/drm_report.pdf.  Accessed March 8, 2007. 
3 The States included in the eight-State report are those that were able to respond to our data request and received 
at least $1 million in the initial appropriation of funds through the Deficit Reduction Act.  These eight States 
account for 99 percent of the initial appropriation of funds. 
4 Each approved 1115 demonstration project included Title XIX waivers, Medicaid costs not otherwise matchable 
(expenditure authority), and special terms and conditions. These demonstration authorities were approved by 
CMS between September 22, 2005, and March 26, 2006, and are on file with CMS.  Page 3  Herb Kuhn 
(DRA)5 used different terminology.  It defined an affected individual as one who resided in a 
county or parish declared to be an emergency area as a result of Katrina and who continued to 
reside in the same State as the emergency area, and an evacuee as an affected individual who 
was displaced to another State. 
The DRA authorized the Secretary to pay the non-Federal share of certain health care-related 
expenses to eligible States.6  Sections 6201(a)(1)(A) and (C) allow the Secretary to reimburse 
States for the non-Federal share of medical assistance provided under an approved  
hurricane-related demonstration project to both evacuees and affected individuals.  In addition, 
Section 6201(a)(3) allows for reimbursement of the non-Federal share for medical assistance 
provided under existing State plans for certain counties or parishes.7  All 32 States that 
received approval for hurricane-related demonstration projects were allocated funds pursuant 
to either Section 6201(a)(1) or 6201(a)(3), or both.   
In February 2006, Section 6201(e) of the DRA appropriated funds for the activities authorized 
in Section 6201. In March 2006, CMS released $1.5 billion to States approved to implement 
hurricane-related demonstration projects.8  Later in 2006, CMS obligated approximately $360 
million in additional DRA funding to approved States.9  Overall, the DRA appropriated $2 
billion in funds for these projects, to remain available until expended; the remainder is 
expected to be dispersed in FY 2007. 
Louisiana was approved for a hurricane-related demonstration project on November 10, 2005, 
and funds were obligated under all Sections of the DRA.  In the initial allocation of DRA 
funds, Louisiana received almost $770 million.  Although Louisiana developed a Disaster 
Relief Medicaid program based on the waiver and expenditure authorities allowed under 
Section 1115 demonstration projects, it did not ultimately submit claims for reimbursement 
under the demonstration projects allowed in Section 6201(a)(1).  Instead, Louisiana primarily 
submitted claims for reimbursement under Section 6201(a)(3) of the DRA, which allows 
reimbursement for services under existing State plans for specific counties or parishes.  
Therefore, the individuals who received Medicaid services in Louisiana as a result of the 
hurricanes were considered affected individuals, rather than evacuees, as they were eligible 
under the existing State plan and resided in an affected parish.  Hereinafter, any discussion of 
payment refers to all submitted claims for Louisiana. 
5 Deficit Reduction Act of 2005, Pub. L. No. 109-171,  6201(b). 

6 Deficit Reduction Act of 2005, Pub. L. No. 109-171,  6201. 

7 Only Louisiana, Alabama, and Mississippi were eligible for reimbursement pursuant to Section 6201(a)(3). 

8 HHS News Release.  HHS Releases First Round of Katrina Aid to 32 States To Help With Affected Individual 

Health Cost.  March 24, 2006.  Available online at http://www.hhs.gov/news/press/2006pres/20060324.html. 

Accessed March 29, 2006. 

9 HHS, CMS.  Fiscal Year 2008: Justification of Estimates for the Appropriation Committees. 
 Page 4  Herb Kuhn 
SCOPE AND METHODOLOGY 
Scope 
This data compendium focuses on the Medicaid payments and services associated with the 
affected individuals who were deemed eligible for such payments and services because they 
resided in an affected parish and received services under an existing State plan.  It does not 
determine whether any Medicaid beneficiaries were wrongly deemed eligible to receive 
Medicaid or provide a medical record review of appropriateness of Medicaid claims.  It also 
does not review payments and services rendered using an uncompensated care pool.  In 
addition, the data are State-reported, administrative data.  Therefore, the payments discussed in 
this report represent the total payments made by the Medicaid program:  the payments have not 
been adjusted to represent rebates, appeals, or the Federal-State share.  Lastly, this data 
compendium does not examine claims related to Medicare or the State Childrens Health 
Insurance Program.  
Methodology 
We analyzed Louisiana Medicaid eligibility and claims data to obtain descriptive information 
regarding hurricane-related payments and services in Louisiana.  We used data from 
Louisianas Medicaid Management Information System (MMIS).  MMIS is a State-level 
system that contains claims data, provider enrollment data, and beneficiary eligibility 
information.   
This report analyzes eligibility and claims data for the first two full quarters of FY 2006 
(October 1, 2005March 31, 2006). This period represents the first two full quarters after the 
hurricanes. Our analysis included only claims for individuals who were Medicaid eligible and 
received a service during our 6-month study period.  Further, we focused our analysis on 
medical services and prescription drugs.  Medical services include outpatient hospital services, 
physician services, and other noninstitutional services.  We did not review inpatient or long-
term care claims.  A contractor assisted with the development of the programming language 
used to analyze the data.  The contractor analyzed medical services data and we analyzed 
prescription drug data. 
We provide descriptive and comparative statistics for Louisiana Medicaid payments and 
services for affected and nonaffected individuals.  For our analysis, the nonaffected individual 
group is used to represent benchmark patterns of payments and utilization. In this report, both 
beneficiaries (affected individuals and nonaffected individuals) and services10 are used as units 
of analysis. For both medical services and prescription drugs, we provide descriptive 
information for total and average payment overall, as well as by month, parish, eligibility 
category, and service type. For service type, we relied on Louisiana State Medicaid definitions  
10 We refer to the service line items in the data as services.  Most service line items equal one service; however, 
there are some cases, such as time dependent codes or unit-dependent codes that may represent more than one 
service. Examples of these are critical care or ambulance miles.  We did not capture these differences.  Page 5  Herb Kuhn 
of Medicaid services. We also provide information on the top 30 procedures and top  
100 affected individuals and providers by paid amount.   
The tables throughout this compendium are sorted in descending order by difference in average 
payment between affected individuals and nonaffected individuals, when a difference exists.  If 
no difference has been calculated, the tables are sorted in descending order by total payments. 
RESULTS 
Louisiana Medicaid Medical Services 
Total Payments 
Total payments by affected individual status are listed in Table 1.  The average payment per 
affected individual in Louisiana for medical services in the first two quarters of FY 2006 was 
$645.14 compared to an average payment per nonaffected individual of $755.71.  There were 
more than twice as many affected individuals as nonaffected individuals. 
Table 1: Medical ServicesPayments by Beneficiaries Individual Status 
Unique Beneficiary  Average Payment 
Individual Status  Count  Total Payment  per Beneficiary 
Affected individuals  667,089  $430,362,515  $645.14 
Nonaffected individuals  312,174  $235,911,588  $755.71 
     Total  979,263  $666,274,103  $680.38 
Source: Contractor analysis of Louisiana Medicaid data, October 1, 2005March 31, 2006. 
Monthly Payments 
Table 2 on the following page displays the total and average payments per beneficiary by 
month. Beneficiaries are counted only once per month if they have any services in that month 
but they may receive services in multiple months.  As the table demonstrates, in each month, 
the average payment per affected individual was less than that per nonaffected individual.  Page 6  Herb Kuhn 
Table 2: Medical ServicesTotal and Average Payment per Beneficiary by Month 
Affected  Total  Average    Nonaffected  Average 
Individuals  Payments for  Payment per  Individuals  Total Payments  Payment per 
Receiving  Affected  Affected  Receiving  for Nonaffected  Nonaffected 
Month  Services  Individuals  Individual Services  Individuals  Individual 
   October 2005  567,772  $72,121,399  $127.03  263,613  $40,421,300  $153.34 
November 2005  566,883  $69,743,739  $123.03  268,524  $38,409,921  $143.04 
December 2005  562,773  $68,450,953  $121.63  268,497  $36,993,792  $137.78 
   January 2006  558,514  $79,203,340  $141.81  268,211  $42,785,497  $159.52 
   February 2006  526,612  $67,698,049  $128.55  267,250  $37,336,467  $139.71 
March 2006  528,504  $73,145,035  $138.40  268,572  $39,964,612  $148.80 
   Total  3,311,058  $430,362,515  $129.98  1,604,667  $235,911,589   $147.02 
Source: Contractor analysis of Louisiana Medicaid data, October 1, 2005March 31, 2006. 
Payment and Beneficiaries by Parish 
Table 3 on the following page displays the total and average payments per beneficiary by 
parish. Of 64 parishes, 24 had greater average payments per affected individual than per 
nonaffected individual. Thirteen of the twenty-four parishes had average payment differences 
per affected individual at least $100 greater than nonaffected individuals.  In Caldwell Parish, 
the average payment per affected individual was more than $1,000 greater than the average per 
nonaffected individual. However, there were only 25 affected individuals in this parish.  
Figures 1 and 2 on page 9 display the distribution of average payments by parish for affected 
and nonaffected individuals, respectively. 
The percentage of beneficiaries who received services in each parish is also outlined in  

Table 3. Three parishesOrleans, Jefferson, and East Baton Rougeaccounted for  

40.9 percent of affected individuals.  These three parishes accounted for less than 1 percent of 
the total nonaffected individual population.  The average payments for affected individuals for 
these three parishes were much less than for nonaffected individuals.  Figures 3 and 4 on 
page 10 provide graphical representation of the affected individual and nonaffected individual 
population distribution by parish, respectively.   Page 7  Herb Kuhn 
Table 3: Medical ServicesTotal and Average Payment by Parish 
Average  Total  Average 
Affected  Percentage  Total  Payment  Nonaffected  Percentage  Payments  Payment 
Individuals  of Total  Payments  per  Individuals  of Total  for  per  Difference 
Receiving  Affected  for Affected  Affected  Receiving  Nonaffected  Nonaffected  Nonaffected  in Average 
Parish  Services  Individuals   Individuals  Individual  Services  Individuals  Individuals  Individuals  Payments 
Caldwell  25  0.00004%  $52,811  $2,112.44  2,837  0.9%  $2,984,935  $1,052.14  $1,060.30 
Allen  6,115  0.9%  $4,170,941  $682.08  202  0.1%  $94,868  $469.64  $212.44 
Caddo  518  0.1%  $449,357  $867.48  58,791  18.8%  $39,859,719  $677.99  $189.49 
Assumption  5,618  0.8%  $4,404,175  $783.94  41  0.01%  $24,480  $597.07  $186.86 
Ascension  14,704  2.2%  $11,141,257  $757.70  197  0.1%  $116,606  $591.91  $165.79 
Claiborne  26  0.00004%  $18,899  $726.88  4,168  1.3%  $2,377,295  $570.37  $156.53 
Lafourche  19,114  2.9%  $15,582,423  $815.24  182  0.1%  $120,312  $661.05  $154.18 
Vernon  8,050  1.2%  $5,631,442  $699.56  188  0.1%  $105,670  $562.07  $137.48 
Acadia  15,781  2.4%  $11,086,493  $702.52  297  0.1%  $168,160  $566.20  $136.33 
Pointe 
Coupee  5,533  0.8%  $4,326,703  $781.98  66  0.0002%  $43,288  $655.88  $126.11 
Iberia  19,385  2.9%  $15,192,495  $783.72  182  0.1%  $121,478  $667.46  $116.26 
St. James  4,915  0.7%  $3,221,210  $655.38  38  0.01%  $20,923  $550.61  $104.77 
St. John the 
Baptist  11,270  1.7%  $6,616,864  $587.12  116  0.04%  $56,479  $486.89  $100.23 
Terrebonne  24,480  3.7%  $18,775,036  $766.95  314  0.1%  $210,401  $670.07  $96.89 
Livingston  19,182  2.9%  $13,600,178  $709.01  340  0.1%  $208,919  $614.47  $94.54 
Jefferson 
Davis  7,554  1.1%  $5,218,872  $690.88  112  0.04%  $67,189  $599.90  $90.98 
Washington  12,992  2.0%  $10,877,263  $837.23  263  0.1%  $196,795  $748.27  $88.96 
West 
Feliciana  1,825  0.3%  $1,504,248  $824.25  24  0.01%  $18,154  $756.42  $67.83 
Sabine  5,068  0.8%  $2,762,532  $545.09  164  0.1%  $79,617  $485.47  $59.62 
St. Mary  15,092  2.3%  $10,115,087  $670.23  174  0.1%  $109,252  $627.89  $42.34 
West Baton 
Rouge  4,395  0.7%  $3,057,851  $695.76  51  0.02%  $33,690  $660.59  $35.16 
East 
Feliciana  4,235  0.6%  $3,367,789  $795.23  71  0.02%  $54,080  $761.69  $33.54 
Beauregard  6,848  1.0%  $4,105,100  $599.46  142  0.1%  $80,662  $568.04  $31.42 
Cameron  1,248  0.2%  $568,826  $455.79  18  0.01%  $8,130  $451.67  $4.11 
St. Helena  2,810  0.4%  $2,379,399  $846.76  30  0.01%  $25,937  $864.57  -$17.79 
St. Charles  8,712  1.3%  $4,736,009  $543.62  53  0.02%  $30,960  $584.15  -$40.53 
La Salle  38  0.01%  $35,307  $929.13  3,000  1.0%  $2,926,597  $975.53  -$46.41 
Lafayette  35,035  5.3%  $28,275,768  $807.07  828  0.3%  $717,834  $866.95  -$59.88 
Vermilion  11,233  1.7%  $7,438,042  $662.16  169  0.1%  $122,034  $722.09  -$59.94 
Calcasieu  37,659  5.7%  $25,148,080  $667.78  600  0.2%  $441,094  $735.16  -$67.37 
Iberville  8,651  1.3%  $6,303,376  $728.63  90  0.0003%  $71,876  $798.62  -$69.99 
St. Landry  879  0.1%  $637,361  $725.10  26,152  8.4%  $19,455,090  $743.92  -$18.83  Page 8  Herb Kuhn 
Table 3: Medical ServicesTotal and Average Payment by Parish - continued 
Average  Total 
Affected  Percentage  Total  Payment  Nonaffected  Percentage  Payments  Average 
Individuals  of Total  Payments  per  Individuals  of Total  for  Payment per  Difference 
Receiving  Affected  for Affected  Affected  Receiving  Nonaffected  Nonaffected  Nonaffected  in Average 
Parish  Services  Individuals   Individuals  Individual  Services  Individuals  Individuals  Individual  Payments 
De Soto  70  0.0001%  $37,475  $535.36  5,975  1.9%  $3,633,967  $608.20  -$72.84 
Madison  55  0.00008%  $33,379  $606.89  4,674  1.5%  $3,225,901  $690.18  -$83.30 
Tangipahoa  30,297  4.5%  $24,695,526  $815.11  463  0.2%  $419,745  $906.58  -$91.46 
Union  23  0.00003%  $12,432  $540.52  5,096  1.6%  $3,297,484  $647.07  -$106.54 
Red River  17  0.00002%  $7,997  $470.41  2,577  0.8%  $1,615,981  $627.08  -$156.70 
Rapides  710  0.1%  $506,379  $713.21  33,009  10.6%  $28,885,429  $875.08  -$161.87 
East Baton 
Rouge  84,124  12.6%  $58,054,633  $690.11  1,103  0.4%  $941,354  $853.45  -$163.34 
Grant  70  0.0001%  $30,028  $428.97  4,894  1.6%  $2,928,768  $598.44  -$169.46 
Jefferson  82,464  12.4%  $45,580,558  $552.73  783  0.3%  $575,711  $735.26  -$182.53 
St. Martin  12,189  1.8%  $9,756,187  $800.41  157  0.1%  $154,690  $985.29  -$184.88 
Plaquemines  4,707  0.7%  $2,109,059  $448.07  44  0.01%  $27,995  $636.25  -$188.18 
St. 
Tammany  29,591  4.4%  $17,951,166  $606.64  496  0.2%  $400,475  $807.41  -$200.77 
Lincoln  157  0.02%  $77,676  $494.75  8,632  2.8%  $6,016,845  $697.04  -$202.29 
Morehouse  76  0.01%  $35,606  $468.50  9,235  3.0%  $6,451,216  $698.56  -$230.06 
Bossier  254  0.04%  $117,846  $463.96  17,217  5.5%  $11,963,139  $694.84  -$230.89 
Webster  51  0.01%  $23,050  $451.96  9,862  3.2%  $6,751,928  $684.64  -$232.68 
East Carroll  34  0.01%  $22,463  $660.68  3,728  1.2%  $3,384,127  $907.76  -$247.09 
Natchitoches  218  0.03%  $90,407  $414.71  9,710  3.1%  $6,648,640  $684.72  -$270.01 
Avoyelles  329  0.1%  $158,991  $483.26  12,624  4.0%  $9,632,776  $763.05  -$279.80 
Evangeline  311  0.1%  $133,651  $429.75  11,334  3.6%  $8,520,127  $751.73  -$321.99 
Jackson  41  0.01%  $16,449  $401.20  3,459  1.1%  $2,513,828  $726.75  -$325.56 
Concordia  156  0.02%  $52,960  $339.49  5,922  1.9%  $3,994,791  $674.57  -$335.08 
Bienville  18  0.00003%  $4,691  $260.61  4,018  1.3%  $2,403,015  $598.06  -$337.44 
Franklin  78  0.01%  $33,075  $424.04  6,796  2.2%  $5,245,346  $771.83  -$347.80 
Winn  49  0.01%  $11,361  $231.86  3,980  1.3%  $2,326,691  $584.60  -$352.73 
Ouachita  510  0.1%  $213,982  $419.57  36,013  11.5%  $29,054,959  $806.79  -$387.22 
West Carroll  50  0.01%  $29,483  $589.66  3,725  1.2%  $3,719,896  $998.63  -$408.97 
Richland  36  0.01%  $13,111  $364.19  6,439  2.1%  $5,214,364  $809.81  -$445.63 
Tensas  74  0.01%  $15,313  $206.93  2,079  0.7%  $1,414,215  $680.24  -$473.30 
Orleans  106,385  16.0%  $34,705,868  $326.23  749  0.2%  $640,115  $854.63  -$528.40 
Catahoula  38  0.01%  $14,425  $379.61  3,026  1.0%  $2,856,442  $943.97  -$564.35 
St. Bernard  10,495  1.6%  $5,016,099  $477.95  78  0.02%  $99,104  $1,270.56  -$792.62 
Total  682,667  100.0%  $430,362,520  $630.41  317,797  100.0%  $235,911,588  $742.33  -$111.92 
Source: Contractor analysis of Louisiana Medicaid data, October 1, 2005March 31, 2006.  Page 9  Herb Kuhn 
Figure 1:  Medical ServicesAverage Payment by Parish for 
Affected Individuals 
Figure 2:  Medical ServicesAverage Payment by Parish for 
Nonaffected Individuals  Page 10  Herb Kuhn 
Figure 3:  Medical ServicesAffected Individual Distribution by 
Parish 
Figure 4:  Medical ServicesNonaffected Individual Distribution 
by Parish  Page 11  Herb Kuhn 
Payments by Eligibility Category 
Tables 4a and 4b summarize total and average payments by eligibility category.  These tables 
differ by the unit of analysis. Table 4a lists the total average payments per beneficiary within 
each eligibility category.  Because beneficiaries may have more than one reason for eligibility, 
beneficiaries may be counted in more than one eligibility category.  Table 4b on the following 
page lists the total and average payments per service within each eligibility category. 
Table 4a shows that in 7 of the 20 eligibility categories, the average payment per affected 
individual was greater than that per nonaffected individual.  Only three of the seven categories 
had a difference in average payments greater than $100.  These three categories are 
Blind/disabled, medically needy; Other blind/disabled; and AFDC adult, medically needy. 
There are nine categories in Table 4b in which the average payment per service was greater for 
affected individuals. However, none of these nine categories had payment differences greater 
than $20. 
Table 4a: Medical ServicesTotal and Average Payments per Beneficiary by Eligibility Category 
Average 
Affected  Total  Payment  Nonaffected  Total  Average 
Individuals  Payments  per  Individuals  Payments for  Payment per  Difference 
Eligibility Category and  Receiving  for Affected  Affected  Receiving  Nonaffected  Nonaffected  in Average 
Description  Services  Individuals  Individual  Services  Individuals  Individual  Payments 
22 - Blind/disabled, medically 
needy (MN)  1,145  $3,130,517  $2,734.08  490  $1,116,492  $2,278.56  $455.52 
42 - Other blind/disabled  10,563  $39,057,517  $3,697.58  4,949  $17,004,045  $3,435.85  $261.73 
25 - Aid to families with dependent 
children (AFDC), adult, MN  3,498  $3,981,218  $1,138.14  1,590  $1,567,831  $986.06  $152.08 
17 - AFDC - unemployed father (U) 
adult, cash  5,294  $3,111,483  $587.74  1,984  $1,114,473  $561.73  $26.01 
35 - Adult, poverty  26,966  $32,553,727  $1,207.21  11,724  $13,871,652  $1,183.18  $24.03 
45 - Other adult  7,089  $2,688,750  $379.28  2,567  $924,870  $360.29  $18.99 
24 - AFDC child, MN  371  $137,595  $370.88  250  $88,575  $354.30  $16.58 
31 - Aged, poverty  9,880  $2,252,731  $228.01  6,321  $1,574,452  $249.08  ($21.07) 
16 - AFDC-U child, cash  4,300  $1,202,789  $279.72  2,024  $641,590  $316.99  ($37.27) 
34 - Child, poverty  347,982  $94,728,571  $272.22  152,069  $47,867,976  $314.78  ($42.56) 
32 - Blind/disabled, poverty  7,238  $2,194,621  $303.21  3,047  $1,083,517  $355.60  ($52.39) 
21 - Aged, MN  531  $332,413  $626.01  351  $243,482  $693.68  ($67.67) 
14 - AFDC child, cash  68,054  $14,887,501  $218.76  34,484  $10,142,519  $294.12  ($75.36) 
15 - AFDC adult, cash  38,091  $20,126,210  $528.37  16,005  $9,704,732  $606.36  ($77.99) 
44 - Other child  43,309  $24,703,652  $570.40  20,620  $13,583,442  $658.75  ($88.35) 
12 - Blind/disabled, cash  88,986  $146,843,465  $1,650.19  44,728  $78,481,877  $1,754.65  ($104.46) 
48 - Foster care child  1,724  $1,093,319  $634.18  6,542  $5,298,365  $809.90  ($175.72) 
11 - Aged, cash  18,249  $16,065,157  $880.33  13,333  $14,097,285  $1,057.32  ($176.99) 
41 - Other aged  11,265  $18,050,860  $1,602.38  8,501  $15,563,798  $1,830.82  ($228.44)  Page 12  Herb Kuhn 
Table 4a: Medical ServicesTotal and Average Payments per Beneficiary by Eligibility Category - continued 
Average  Average 
Affected  Total  Payment  Nonaffected  Payment 
Individuals  Payments  per  Individuals  Total Payments  per  Difference in 
Eligibility Category and  Receiving  for Affected  Affected  Receiving  for Nonaffected  Nonaffected  Average 
Description  Services  Individuals  Individual  Services  Individuals  Individual  Payments 
3A - Individual covered under the  
   Breast and Cervical Cancer  
   Prevention Act of 2000, poverty  596  $3,220,419  $5,403.39  340  $1,940,616  $5,707.69  ($304.30) 
Total  695,131  $430,362,515  $619.11  331,919  $235,911,589  $710.75  ($91.64) 
Source: Contractor analysis of Louisiana Medicaid data, October 1, 2005March 31, 2006. 
Table 4b: Medical ServicesTotal and Average Payments per Service by Eligible Category 
Average  Average 
Number of  Total  Payment Per  Number of  Total  Payment Per 
Affected  Payments for  Affected  Nonaffected  Payments for  Nonaffected  Difference 
Eligibility Category and  Individual  Affected  Individual  Individual  Nonaffected  Individual  in Average 
Description  Services  Individuals  Service  Services  Individuals  Service  Payments 
22 - Blind/disabled, MN  34,160  $3,130,517  $91.64  15,396  $1,116,492  $72.52  $19.12 
3A - Individual covered under 
the Breast and Cervical 
Cancer Prevention Act of 
2000, poverty  28,708  $3,220,419  $112.18  19,953  $1,940,616  $97.26  $14.92 
25 - AFDC adult, MN  58,854  $3,981,218  $67.65  26,396  $1,567,831  $59.40  $8.25 
24 - AFDC child, MN  3,271  $137,595  $42.07  2,501  $88,575  $35.42  $6.65 
42 - Other blind/disabled  278,044  $39,057,517  $140.47  126,039  $17,004,045  $134.91  $5.56 
12 - Blind/disabled, cash  2,033,783  $146,843,465  $72.20  1,159,508  $78,481,877  $67.69  $4.51 
17 - AFDC-U adult, cash  72,674  $3,111,483  $42.81  28,463  $1,114,473  $39.16  $3.65 
35 - Adult, poverty  637,665  $32,553,727  $51.05  285,082  $13,871,652  $48.66  $2.39 
45 - Other adult  74,829  $2,688,750  $35.93  27,197  $924,870  $34.01  $1.92 
31 - Aged, poverty  162,192  $2,252,731  $13.89  109,634  $1,574,452  $14.36  ($0.47) 
15 - AFDC adult, cash  560,855  $20,126,210  $35.88  264,257  $9,704,732  $36.72  ($0.84) 
16 - AFDC-U child, cash  49,003  $1,202,789  $24.55  25,220  $641,590  $25.44  ($0.89) 
34 - Child, poverty  4,326,660  $94,728,571  $21.89  2,052,524  $47,867,976  $23.32  ($1.43) 
32 - Blind/disabled, poverty  115,298  $2,194,621  $19.03  51,151  $1,083,517  $21.18  ($2.15) 
14 - AFDC child, cash  714,916  $14,887,501  $20.82  424,647  $10,142,519  $23.88  ($3.06) 
44 - Other child  808,843  $24,703,652  $30.54  391,864  $13,583,442  $34.66  ($4.12) 
11 - Aged, cash  375,808  $16,065,157  $42.75  298,566  $14,097,285  $47.22  ($4.47) 
41 - Other aged  252,787  $18,050,860  $71.41  203,248  $15,563,798  $76.58  ($5.17) 
21 - Aged, MN  7,885  $332,413  $42.16  4,954  $243,482  $49.15  ($6.99) 
48 - Foster care child  23,832  $1,093,319  $45.88  97,670  $5,298,365  $54.25  ($8.37) 
   Total  10,620,067  $430,362,515  $40.52  5,614,270  $235,911,588   $42.02  ($1.50) 
Source: Contractor analysis of Louisiana Medicaid data, October 1, 2005March 31, 2006.  Page 13  Herb Kuhn 
Payments by Service Type 
Tables 5a and 5b summarize total and average payment by service type, as defined by the 
Louisiana State Medicaid program.  These tables differ by the unit of analysis.  Table 5a lists 
the total average payments per beneficiary within each service type.  Because beneficiaries 
may have more than one service, they may be counted in more than one service type.  Table 5b 
on page 15 displays the total payment and average payment per service within each service 
type. 
In Table 5a, there are 14 service types in which the average payment per affected individual 
was greater than per nonaffected individual. Nine of the fourteen service types had average 
payments per affected individual more than $20 greater than that per nonaffected individual.  
Three service types were more than $100 greater than that for affected individuals:  home 
health, mental health rehabilitation, and enhanced outpatient rehabilitation services. 
In Table 5b, there are 16 service types in which the average payment per service type for 
affected individuals was greater than for nonaffected individuals.  In only four of these service 
types were average payments per service for affected individuals more than $20 greater than 
that for nonaffected individuals. 
Table 5a:  Medical ServicesTotal and Average Payments per Beneficiary by Service Type 
Average  Total  Average 
Affected  Payment  Nonaffected  Payments  Payment 
Individuals  Total Payments  per  Individuals  for  per  Difference 
Receiving  for Affected  Affected  Receiving  Nonaffected  Nonaffected  in Average 
Service Type  Services  Individuals  Individual  Services  Individuals  Individual  Payments 
Home health  3,691  $6,126,143  $1,659.75  3,166  $4,629,988  $1,462.41  $197.34 
Mental health 
rehabilitation  2,221  $6,044,009  $2,721.30  2,268  $5,775,367  $2,546.46  $174.84 
Enhanced outpatient 
rehab services  152  $28,573  $187.98  126  $9,951  $78.97  $109.01 
Childnet (Early Steps)  1,293  $930,502  $719.65  574  $367,130  $639.60  $80.05 
Other1  109,048  $24,600,807  $225.60  86,028  $13,697,946  $159.23  $66.37 
Psychological and 
behavioral services  102  $14,810  $145.20  2  $215  $107.50  $37.70 
Not applicable - 00  1,408  $1,285,486  $912.99  933  $825,152  $884.41  $28.58 
School boards and 
early intervention 
centers  15,621  $4,205,510  $269.22  8,494  $2,092,529  $246.35  $22.87 
Expanded dental 
services for pregnant 
women  889  $97,149  $109.28  367  $31,896  $86.91  $22.37 
Anesthesia  31,204  $5,572,660  $178.59  17,117  $2,748,933  $160.60  $17.99 
Assistant surgeon  2,962  $499,791  $168.73  843  $132,124  $156.73  $12.00 
1Other includes durable medical equipment, emergency ambulance services, prenatal care clinic services, EPSDT case 
management, ventilator-assisted childrens program (VACP), nurse home visits, infants and toddlers, HIV, high-risk pregnant 
women, vision eyeglass program, personal care services (EPSDT), rehabilitation centers.  Page 14  Herb Kuhn 
Table 5a:  Medical ServicesTotal and Average Payments per Beneficiary by Service Type - continued 
Average  Total  Average 
Affected  Payment  Nonaffected  Payments  Payment 
Individuals  Total Payments  per  Individuals  for  per  Difference 
Receiving  for Affected  Affected  Receiving  Nonaffected  Nonaffected  in Average 
Service Type  Services  Individuals  Individual  Services  Individuals  Individual  Payments 
Professional 
component  124,563  $8,815,621  $70.77  73,213  $4,540,634  $62.02  $8.75 
Early periodic 
screening, diagnosis, 
and treatment (EPSDT)  186,188  $21,711,786  $116.61  98,680  $11,260,743  $114.11  $2.50 
Office of Public Health  40,955  $1,217,083  $29.72  32,742  $940,145  $28.71  $1.01 
Dental  1,334  $880,846  $660.30  914  $606,878  $663.98  ($3.68) 
Deficit Reduction Act 
(DEFRA), lab 62%, 
ambulatory surgery  3,530  $861,133  $243.95  2,200  $550,236  $250.11  ($6.16) 
Family planning clinics  4,248  $407,747  $95.99  3,408  $370,807  $108.80  ($12.81) 
Rural health clinic 
(RHC), Federally 
Qualified Health Clinic 
(FQHC), 
CommunityCARE 
enhanced  159,484  $28,518,643  $178.82  94,910  $18,802,434  $198.11  ($19.29) 
Not applicable - 28  30  $6,631  $221.03  7  $1,721  $245.86  ($24.83) 
Full-service physician  637,511  $189,381,528  $297.06  287,561  $94,673,765  $329.23  ($32.17) 
Mental health  10,347  $3,490,647  $337.36  4,051  $1,583,913  $390.99  ($53.63) 
Missing  29,541  $13,559,997  $459.02  20,911  $11,702,835  $559.65  ($100.63) 
Case management 
EPSDT  3  $1,760  $586.50  2  $1,377  $688.50  ($102.00) 
Personal care services 
(long-term care)  3,140  $19,840,961  $6,318.78  2,245  $14,681,220  $6,539.52  ($220.74) 
Waiver - children's 
choice  590  $2,209,453  $3,744.84  187  $870,661  $4,655.94  ($911.10) 
Waiver - Elderly and 
Disabled Adult (EDA)  1,646  $8,889,656  $5,400.76  1,140  $7,312,340  $6,414.33  ($1,013.57) 
Supports waiver  3,347  $81,163,583  $24,249.65  1,244  $37,700,648  $30,305.99  ($6,056.34) 
Total  1,375,048   $430,362,515  $312.98  743,333  $235,911,588   $317.37  ($4.39) 
Source: Contractor analysis of Louisiana Medicaid data, October 1, 2005March 31, 2006.  Page 15  Herb Kuhn 
Table 5b: Medical ServicesTotal and Average Payments per Service by Service Type 
Average  Average 
Number  Payment  Payment 
of  Total  per  Number of  Total  Per 
Affected  Payments  Affected  Nonaffected  Payments for  Nonaffected  Difference 
Individual  for Affected  Individual  Individual  Nonaffected  Individual  in Average 
Type of Service  Services  Individuals  Service  Services  Individuals  Service  Payments 
Not applicable - 00  3,515  $1,285,486  $365.71  2,551  $825,152  $323.46  $42.25 
Personal care services 
(long-term care)  57,170  $19,840,961  $347.05  46,671  $14,681,220  $314.57  $32.48 
Waiver - children's 
choice  12,269  $2,209,453  $180.08  5,613  $870,661  $155.12  $24.96 
Assistant surgeon  3,351  $499,791  $149.15  1,033  $132,124  $127.90  $21.25 
Other1  551,593  $24,600,807  $44.60  454,760  $13,697,946  $30.12  $14.48 
New opportunity 
waiver (NOW)  162,536  $81,163,583  $499.36  77,340  $37,700,648  $487.47  $11.89 
Enhanced outpatient 
rehab services  550  $28,573  $51.95  233  $9,951  $42.71  $9.24 
Home health  56,862  $6,126,143  $107.74  46,465  $4,629,988  $99.64  $8.10 
Mental health 
rehabilitation  57,323  $6,044,009  $105.44  56,794  $5,775,367  $101.69  $3.75 
Professional 
component  403,165  $8,815,621  $21.87  240,122  $4,540,634  $18.91  $2.96 
Case management -  
EPSDT  44  $1,760  $39.99  37  $1,377  $37.22  $2.77 
Expanded dental 
services for pregnant 
women  3,823  $97,149  $25.41  1,369  $31,896  $23.30  $2.11 
Anesthesia  50,578  $5,572,660  $110.18  25,218  $2,748,933  $109.01  $1.17 
Childnet (Early Steps)  15,960  $930,502  $58.30  6,358  $367,130  $57.74  $0.56 
EPSDT, EPSDT dental  749,892  $21,711,786  $28.95  392,801  $11,260,743  $28.67  $0.28 
Office of Public Health  58,202  $1,217,083  $20.91  45,488  $940,145  $20.67  $0.24 
Missing  78,824  $13,559,997  $172.03  68,016  $11,702,835  $172.06  ($0.03) 
School boards and 
early intervention 
centers  265,376  $4,205,510  $15.85  131,544  $2,092,529  $15.91  ($0.06) 
Full-service physician  7,566,755  $189,381,528  $25.03  3,687,240  $94,673,765  $25.68  ($0.65) 
Psychological and 
behavioral services  212  $14,810  $69.86  3  $215  $71.77  ($1.91) 
Family planning clinics  14,348  $407,747  $28.42  12,029  $370,807  $30.83  ($2.41) 
Dental  3,433  $880,846  $256.58  2,341  $606,878  $259.24  ($2.66) 
Mental health  36,767  $3,490,647  $94.94  16,185  $1,583,913  $97.86  ($2.92) 
RHC, FQHC, 
CommunityCARE 
Enhanced  402,953  $28,518,643  $70.77  244,517  $18,802,434  $76.90  ($6.13) 
Not applicable - 28  183  $6,631  $36.23  39  $1,721  $44.13  ($7.90)
1Other includes durable medical equipment, emergency ambulance services, prenatal care clinic services, EPSDT case 
management, VACP, nurse home visits, infants and toddlers, HIV, high-risk pregnant women, vision eyeglass program, personal 
care services (EPSDT), rehabilitation centers.  Page 16  Herb Kuhn 
Table 5b: Medical ServicesTotal and Average Payments per Service by Service Type - continued 
Average  Average 
Payment  Payment 
Number of  Total  per  Number of  Total  Per 
Affected  Payments  Affected  Nonaffected  Payments for  Nonaffected  Difference in 
Individual  for Affected  Individual  Individual  Nonaffected  Individual  Average 
Type of Service  Services  Individuals  Service  Services  Individuals  Service  Payments 
Waiver - EDA  60,257  $8,889,656  $147.53  47,033  $7,312,340  $155.47  ($7.94) 
DEFRA, lab 62%, 
ambulatory surgery  4,126  $861,133  $208.71  2,470  $550,236  $222.77  ($14.06) 
   Total  10,620,067  $430,362,515  $40.52  5,614,270  $235,911,588   $42.02  ($1.50) 
Source: Contractor analysis of Louisiana Medicaid data, October 1, 2005March 31, 2006. 
Top 30 Procedure Codes Paid Amount for Affected Individual Medical Services 
Tables 6a and 6b on the following pages summarize total and average payment by the top 30 
procedures codes11 paid for affected individuals. Procedure codes are specific billing units that 
are generally grouped by service type. Tables 6a and 6b differ on the unit of analysis.  Table 
6a lists the total and average payments per beneficiary within each procedure code.  Because 
beneficiaries may have more than one procedure, they may be counted under more than one 
procedure code. Table 6b displays the total payment and average payment per service within 
each procedure code.  The top 30 procedure codes in Tables 6a and 6b were responsible for 59 
percent of total payments for affected individuals in these two quarters. 
In Table 6a, there were 13 procedure codes in which the average payment per affected 
individual was greater than per nonaffected individual.  Five of the thirteen procedure codes 
had average payments per affected individual more than $20 greater than that for nonaffected 
individuals, and just one was greater than $100.  That procedure code was HR 2015, a type of 
community support service. 
There are 18 procedure codes in Table 6b in which the average payment per service was 
greater for affected individuals than for nonaffected individuals.  Three of the eighteen 
procedure codes had average payments per affected individual service more than $20 greater 
than per nonaffected individual service. 
11 Procedure codes can include Common Procedural Terminology (CPT) codes and Level II Healthcare Common 
Procedure Coding System (HCPCS) codes. CPT codes are a numeric coding system consisting of descriptive 
terms that are used primarily to describe medical services and procedures furnished by physicians and other health 
care practitioners.  HCPCS codes describe products, supplies, and services not included in the CPT codes.   Page 17  Herb Kuhn 
Table 6a:  Medical ServicesTotal and Average Payments per Affected Individual by Top 30 Paid Procedures 
for Affected Individuals 
Average  Total 
Affected  Total  Payment  Nonaffected  Payments  Average 
Individuals  Payments  per  Individuals  for  Payment per  Difference 
Procedure Code and Short  Receiving  for Affected  Affected  Receiving  Nonaffected  Nonaffected  in Average 
Description  Services  Individuals  Individual  Services  Individuals  Individual  Payments 
H2015: Comprehensive 
community support services per 
15 minutes  2,168  $3,745,718  $1,727.73  2,192  $3,554,419  $1,621.54  $106.19 
59515: Cesarean delivery  4,336  $4,583,951  $1,057.18  2,043  $2,071,447  $1,013.92  $43.26 
HR490: Revenue code - 
ambulatory surgery - general  14,120  $7,283,149  $515.80  7,418  $3,571,547  $481.47  $34.33 
92508: Speech/hearing therapy  12,102  $3,523,070  $291.11  6,336  $1,687,118  $266.27  $24.84 
A0427: ALS1 - emergency  19,139  $6,309,471  $329.67  10,567  $3,264,596  $308.94  $20.73 
99232: Subsequent hospital care  21,449  $2,126,061  $99.12  14,220  $1,225,556  $86.19  $12.93 
HR250: Revenue code -
pharmacy - general  66,648  $7,581,851  $113.76  40,659  $4,160,346  $102.32  $11.44 
HR450: Revenue code - 
emergency room - general  124,099  $15,215,949  $122.61  61,847  $6,980,235  $112.86  $9.75 
99391: Preventive visit, 
established (est), infant  23,241  $2,113,212  $90.93  11,093  $912,550  $82.26  $8.67 
HR301: Revenue code - 
chemistry  49,957  $2,417,546  $48.39  19,635  $831,141  $42.33  $6.06 
99213: Office/outpatient visit, est  255,618  $19,242,827  $75.28  115,833  $8,098,928  $69.92  $5.36 
HR402: Revenue code - 
ultrasound  15,821  $2,858,258  $180.66  7,322  $1,287,582  $175.85  $4.81 
99214: Office/outpatient visit, est  92,372  $5,778,467  $62.56  43,111  $2,627,547  $60.95  $1.61 
CC001: Community care - 
Primary Care Provider (PCP) 
management fee  514,085  $8,318,025  $16.18  239,837  $3,976,904  $16.58  ($0.40) 
99212: Office/outpatient visit, est  117,983  $5,935,148  $50.31  60,458  $3,083,700  $51.01  ($0.70) 
99283: Emergency dept visit  78,637  $3,349,515  $42.59  45,669  $1,998,766  $43.77  ($1.18) 
01967: Anesth/analg, vaginal 
delivery  7,496  $2,277,834  $303.87  2,844  $875,497  $307.84  ($3.97) 
T1015: Clinic service  30,566  $8,116,693  $265.55  32,202  $8,723,268  $270.89  ($5.34) 
HR320: Revenue code -  
radiology - general  51,017  $4,718,248  $92.48  28,513  $2,877,092  $100.90  ($8.42) 
HR300: Revenue code - 
laboratory - general  68,988  $2,604,058  $37.75  40,140  $2,284,521  $56.91  ($19.16) 
59410: Obstetrical care  7,239  $5,597,083  $773.18  3,122  $2,499,663  $800.66  ($27.48) 
Z0637: Home and Community 
Based Services (HCBS) waiver - 
case management  3,276  $2,827,178  $863.00  1,227  $1,110,625  $905.16  ($42.16) 
HR352: Revenue code - body 
scan  3,723  $2,466,488  $662.50  1,704  $1,225,383  $719.12  ($56.62) 
Missing  29,541  $13,559,997  $459.02  20,911  $11,702,835  $559.65  ($100.63) 
S5136: Adult companion care 
per diem  1,041  $3,412,936  $3,278.52  604  $2,095,960  $3,470.13  ($191.61)  Page 18  Herb Kuhn 
Table 6a:  Medical ServicesTotal and Average Payments per Affected Individual by Top 30 Paid 
Procedures for Affected Individuals - continued 
Average  Total  Average 
Affected  Total  Payment  Nonaffected  Payments  Payment 
Individuals  Payments  per  Individuals  for  per  Difference 
Procedure Code and Short  Receiving  for Affected  Affected  Receiving  Nonaffected  Nonaffected  in Average 
Description  Services  Individuals  Individual  Services  Individuals  Individual  Payments 
T1019: Personal care service per 
15 minutes  3,914  $22,194,275  $5,670.48  2,530  $15,590,388  $6,162.21  ($491.73) 
S5135: Adult companion care per 
15 minutes  1,438  $5,553,347  $3,861.85  1,085  $5,647,153  $5,204.75  ($1,342.90) 
HR821: Revenue code - 
hemodialysis - composite  690  $2,522,345  $3,655.57  303  $1,568,259  $5,175.77  ($1,520.20) 
S9124: Nursing care, in the 
home; by registered nurse, per 
hour  192  $3,883,949  $20,228.90  114  $2,542,538  $22,302.97  ($2,074.07) 
S5125: Attendant care service 
per 15 minutes  3,488  $71,996,793  $20,641.28  1,331  $33,645,028  $25,278.01  ($4,636.73) 
All other codes  3,438,200  $178,249,076  $51.84  1,782,612  $94,190,996  $52.84  ($1.00) 
Total  5,062,584  $430,362,515  $85.01  2,607,482  $235,911,588  $90.47  ($5.47) 
Source: Contractor analysis of Louisiana Medicaid data, October 1, 2005March 31, 2006. 
Table 6b: Medical ServicesTotal and Average Payments per Service by Top 30 Paid Procedures for 
Affected Individuals 
Average  Average 
Total  Payment  Total  Payment 
 Affected  Payments for  per  Nonaffected  Payments for  per  Difference 
Procedure Code and Short  Individual   Affected  Affected  Individual  Nonaffected  Nonaffected  in Average 
Description  Services  Individuals  Individual  Services  Individuals   Individual  Payments 
S5125: Attendant care 
service per 15 minutes  113,206  $71,996,793  $635.98  58,296  $33,645,028  $577.14  $58.84 
T1019: Personal care ser 
per 15 minutes  67,720  $22,194,275  $327.74  52,145  $15,590,388  $298.98  $28.75 
HR490: Revenue code  
ambulatory surgery - general  15,551  $7,283,149  $468.34  8,014  $3,571,547  $445.66  $22.68 
A0427: ALS1 - emergency  27,178  $6,309,471  $232.15  15,088  $3,264,596  $216.37  $15.78 
HR250: Revenue code - 
pharmacy - general  104,945  $7,581,851  $72.25  72,025  $4,160,346  $57.76  $14.48 
H2015: Comprehensive 
community support services, 
per 15 minutes  28,930  $3,745,718  $129.48  30,313  $3,554,419  $117.26  $12.22 
HR821: Revenue Code - 
hemodialysis - composite  17,038  $2,522,345  $148.04  11,431  $1,568,259  $137.19  $10.85 
HR450: Revenue code - 
emergency room - general  202,886  $15,215,949  $75.00  102,221  $6,980,235  $68.29  $6.71 
99391: Preventive visit, est, 
infant  42,529  $2,113,212  $49.69  19,528  $912,550  $46.73  $2.96 
99214: Office/outpatient 
visit, est  157,823  $5,778,467  $36.61  75,391  $2,627,547  $34.85  $1.76  Page 19  Herb Kuhn 
Table 6b: Medical ServicesTotal and Average Payments per Service by Top 30 Paid Procedures for Affected 
Individuals - continued 
Average 
Total Payments  Average  Total Payments  Payment 
 Affected  for  Payment   Nonaffected  for  per  Difference 
Procedure Code and Short  Individual   Affected  per Affected  Individual  Nonaffected  Nonaffected  in Average 
Description  Services  Individuals  Individual Services  Individuals   Individual  Payments 
99213: Office/outpatient visit, 
est  613,797  $19,242,827  $31.35  272,949  $8,098,928  $29.67  $1.68 
99232: Subsequent hospital 
care  128,952  $2,126,061  $16.49  79,375  $1,225,556  $15.44  $1.05 
T1015: Clinic service  78,592  $8,116,693  $103.28  85,205  $8,723,268  $102.38  $0.90 
01967: Anesth/analg, vaginal 
delivery  8,598  $2,277,834  $264.93  3,313  $875,497  $264.26  $0.67 
HR301: Revenue code - 
chemistry  172,120  $2,417,546  $14.05  61,995  $831,141  $13.41  $0.64 
99212: Office/outpatient visit, 
est  212,947  $5,935,148  $27.87  112,533  $3,083,700  $27.40  $0.47 
92508: Speech/hearing therapy  231,503  $3,523,070  $15.22  113,309  $1,687,118  $14.89  $0.33 
99283: Emergency dept visit  101,916  $3,349,515  $32.87  61,023  $1,998,766  $32.75  $0.11 
CC001: Community care- PCP 
management fee  2,772,789  $8,318,025  $3.00  1,325,652  $3,976,904  $3.00  ($0.00) 
Missing  78,824  $13,559,997  $172.03  68,016  $11,702,835  $172.06  ($0.03) 
Z0637: HCBS waiver - case 
management  17,739  $2,827,178  $159.38  6,947  $1,110,625  $159.87  ($0.49) 
HR300: Revenue code - 
laboratory - general  247,094  $2,604,058  $10.54  202,821  $2,284,521  $11.26  ($0.73) 
S5135: Adult companioncare 
per 15 minutes  29,925  $5,553,347  $185.58  29,941  $5,647,153  $188.61  ($3.03) 
S5136: Adult companioncare 
per diem  17,250  $3,412,936  $197.85  10,269  $2,095,960  $204.11  ($6.25) 
HR320: Revenue code  
radiology - general  79,510  $4,718,248  $59.34  43,831  $2,877,092  $65.64  ($6.30) 
S9124: Nursing care, in the 
home; by registered nurse, per 
hour  17,776  $3,883,949  $218.49  11,144  $2,542,538  $228.15  ($9.66) 
HR402: Revenue code - 
ultrasound  27,572  $2,858,258  $103.67  10,755  $1,287,582  $119.72  ($16.05) 
HR352: Revenue code - body 
scan  6,839  $2,466,488  $360.65  3,161  $1,225,383  $387.66  ($27.01) 
59410: Obstetrical care  7,250  $5,597,083  $772.01  3,126  $2,499,663  $799.64  ($27.62) 
59515: Cesarean delivery  6,107  $4,583,951  $750.61  2,453  $2,071,447  $844.45  ($93.85) 
All other codes  4,985,161  $178,249,076  $35.76  2,662,000  $94,190,996  $35.38  $0.37 
   Total  10,620,067  $430,362,515  $40.52  5,614,270  $235,911,588   $42.02  ($1.50) 
Source: OIG analysis of Louisiana Medicaid data, October 1, 2005March 31, 2006.  Page 20  Herb Kuhn 
Top 100 Affected Individuals by Paid Amount 
Table 7 lists the number of services and payments for the top 100 affected individuals by 
allowed Medicaid payments. Total service payments for the top 100 affected individuals 
ranged from $102,452 to $55,788, with a median payment of $60,494.  Six of these affected 
individuals had payments greater than $80,000 in allowed Medicaid payments during the first 
two quarters of FY 2006, receiving from 71 to 214 services. 
Table 7: Medical ServicesTop 100 Affected Individuals by Total 
Payments for Medical Services 
Rank Among Affected  Total Payments for Affected 
Individuals  Number of Services  Individuals 
1  138  $102,452 
2  141  $97,301 
3  145  $92,278 
4  203  $87,677 
5  71  $85,864 
6  214  $85,345 
7  144  $79,181 
8  222  $79,027 
9  258  $78,952 
10  189  $78,157 
11  258  $76,912 
12  289  $76,826 
13  256  $75,578 
14  244  $72,128 
15  150  $71,362 
16  90  $70,362 
17  486  $70,197 
18  330  $69,037 
19  324  $68,405 
20  358  $68,375 
21  222  $67,886 
22  51  $67,503 
23  58  $66,770 
24  89  $66,302 
25  62  $66,259 
26  60  $66,152 
27  104  $65,835 
28  43  $65,337 
29  208  $64,731 
30  106  $64,544 
31  205  $64,348 
32  547  $63,889 
33  34  $63,795  Page 21  Herb Kuhn 
Table 7: Medical ServicesTop 100 Affected Individuals by Total 
Payments for Medical Services - continued 
Rank Among Affected  Total Payments for Affected 
Individuals  Number of Services  Individuals 
34  253  $63,758 
35  150  $63,708 
36  207  $63,368 
37  295  $62,810 
38  200  $62,586 
39  70  $62,258 
40  272  $61,206 
41  94  $61,132 
42  121  $61,062 
43  277  $61,033 
44  135  $60,979 
45  328  $60,956 
46  86  $60,812 
47  110  $60,631 
48  195  $60,536 
49  368  $60,500 
50  78  $60,499 
51  158  $60,489 
52  292  $60,481 
53  233  $60,416 
54  242  $60,272 
55  119  $60,000 
56  160  $59,483 
57  248  $59,284 
58  101  $58,850 
59  181  $58,840 
60  282  $58,803 
61  283  $58,704 
62  270  $58,438 
63  57  $58,425 
64  204  $58,129 
65  418  $57,916 
66  80  $57,748 
67  153  $57,746 
68  99  $57,695 
69  71  $57,623 
70  245  $57,321 
71  217  $57,252 
72  139  $57,013 
73  49  $56,976  Page 22  Herb Kuhn 
Table 7: Medical ServicesTop 100 Affected Individuals by Total 
Payments for Medical Services - continued 
Rank Among Affected  Total Payments for Affected 
Individuals  Number of Services  Individuals 
74  184  $56,947 
75  87  $56,927 
76  251  $56,771 
77  255  $56,573 
78  207  $56,423 
79  242  $56,414 
80  79  $56,262 
81  71  $56,232 
82  102  $56,215 
83  91  $56,121 
84  119  $56,082 
85  34  $56,058 
86  75  $55,984 
87  422  $55,971 
88  67  $55,954 
89  64  $55,940 
90  87  $55,919 
91  68  $55,910 
92  115  $55,863 
93  54  $55,855 
94  111  $55,854 
95  93  $55,853 
96  54  $55,843 
97  91  $55,832 
98  72  $55,827 
99  59  $55,791 
100  53  $55,788 
Source: Contractor analysis of Louisiana Medicaid data, October 1, 2005March 31, 2006. 
Top 100 Service Providers by Medicaid Paid Amount for Medical Services 
Table 8 on the following page lists the top 100 Louisiana providers, by Medicaid paid amount, 
that provided services to affected individuals.  There were 30 service providers with average 
payments for affected individuals at least $100 greater per service than for nonaffected 
individuals; 9 were at least $1,000 greater for affected individuals than for nonaffected 
individuals. However, 20 of the 30 provided Medicaid services exclusively to affected 
individuals. The other 10 providers predominately provided Medicaid services to affected 
individuals.  Page 23  Herb Kuhn 
Table 8: Medical ServicesTop 100 Service Providers by Total Affected Individual Payments 
Average  Average 
Number of  Total  Payment per  Number of  Total  Payment per 
Affected  Payments for  Affected  Nonaffected  Payments for  Nonaffected  Difference 
Provider  Individual  Affected  Individual  Individuals  Nonaffected  Individual  in Average 
Number  Services  Individuals  Service  Services  Individuals  Service  Payments 
0092713  573  $907,853  $1,584.39  0  $0  $0.00  $1,584.39 
0098510  543  $769,552  $1,417.22  0  $0  $0.00  $1,417.22 
0093587  864  $1,207,815  $1,397.93  0  $0  $0.00  $1,397.93 
0043366  786  $1,012,294  $1,287.91  0  $0  $0.00  $1,287.91 
0058073  582  $939,665  $1,614.55  3  $1,217  $405.67  $1,208.88 
0091432  631  $726,027  $1,150.60  0  $0  $0.00  $1,150.60 
0095702  4,188  $4,621,936  $1,103.61  0  $0  $0.00  $1,103.61 
0066628  615  $648,512  $1,054.49  0  $0  $0.00  $1,054.49 
0067969  1,923  $1,977,737  $1,028.46  0  $0  $0.00  $1,028.46 
0069769  404  $595,698  $1,474.50  1  $560  $560.00  $914.50 
0053940  778  $687,377  $883.52  0  $0  $0.00  $883.52 
0053663  1,056  $756,863  $716.73  0  $0  $0.00  $716.73 
0014893  824  $572,556  $694.85  0  $0  $0.00  $694.85 
0058000  424  $698,014  $1,646.26  38  $37,569  $988.66  $657.60 
0095031  5,875  $3,853,896  $655.98  0  $0  $0.00  $655.98 
0095824  2,480  $1,568,346  $632.40  0  $0  $0.00  $632.40 
0016979  1,006  $617,252  $613.57  0  $0  $0.00  $613.57 
0016914  1,159  $573,969  $495.23  0  $0  $0.00  $495.23 
0091068  917  $1,066,354  $1,162.87  4  $2,674  $668.50  $494.37 
0091291  1,957  $1,702,486  $869.95  15  $5,985  $399.00  $470.95 
0091571  1,595  $712,707  $446.84  23  $858  $37.30  $409.54 
0092641  2,725  $863,700  $316.95  0  $0  $0.00  $316.95 
0093516  1,380  $1,135,587  $822.89  7  $4,024  $574.86  $248.03 
0040602  3,110  $746,613  $240.07  0  $0  $0.00  $240.07 
0069799  1,146  $1,310,337  $1,143.40  220  $218,376  $992.62  $150.78 
0067164  4,112  $596,171  $144.98  0  $0  $0.00  $144.98 
0040276  2,191  $631,374  $288.17  129  $18,494  $143.36  $144.81 
0068978  6,628  $752,488  $113.53  0  $0  $0.00  $113.53 
0099693  7,036  $781,176  $111.03  0  $0  $0.00  $111.03 
0091911  3,007  $1,331,201  $442.70  18  $6,017  $334.25  $108.45 
0066392  641  $619,482  $966.43  14  $12,366  $833.29  $133.14 
0095474  731  $941,021  $1,287.31  524  $635,881  $1,213.51  $73.80 
0054428  5,391  $2,697,454  $500.36  139  $63,854  $459.38  $40.98 
0043269  4,566  $578,093  $126.61  220  $21,368  $97.13  $29.48 
0072025  19,284  $1,186,135  $61.51  511  $19,021  $37.22  $24.29 
0091038  1,225  $1,164,708  $950.78  266  $247,052  $928.77  $22.01 
0070024  19,655  $674,061  $34.29  2,552  $31,414  $12.31  $21.98  Page 24  Herb Kuhn 
Table 8: Medical ServicesTop 100 Service Providers by Total Affected Individual Payments - 
continued 
Average  Average 
Number of  Total  Payment Per  Number of  Total  Payment Per 
Affected  Payments for  Affected  Nonaffected  Payments for  Nonaffected  Difference 
Provider  Individual   Affected  Individual  Individuals  Nonaffected  Individual   in Average 
Number  Services  Individuals  Service  Services  Individuals  Service  Payments 
0072047  11,558  $890,797  $77.07  98  $5,550  $56.63  $20.44 
0073404  13,578  $800,584  $58.96  252  $9,828  $39.00  $19.96 
0076056  19,450  $1,068,955  $54.96  405  $16,557  $40.88  $14.08 
0073278  39,371  $1,983,688  $50.38  597  $23,506  $39.37  $11.01 
0073922  71,292  $4,511,974  $63.29  443  $23,533  $53.12  $10.17 
0076767  19,621  $894,687  $45.60  748  $26,516  $35.45  $10.15 
0072040  13,479  $957,466  $71.03  557  $34,169  $61.35  $9.68 
0072018  10,916  $646,176  $59.20  53  $2,692  $50.79  $8.41 
0072026  77,512  $3,957,865  $51.06  1,302  $56,780  $43.61  $7.45 
0076773  15,332  $691,125  $45.08  409  $15,443  $37.76  $7.32 
0073048  17,078  $789,159  $46.21  314  $12,237  $38.97  $7.24 
0074561  11,549  $624,168  $54.05  535  $25,044  $46.81  $7.24 
0072033  25,586  $889,433  $34.76  358  $10,069  $28.12  $6.64 
0072024  10,789  $584,314  $54.16  501  $23,853  $47.61  $6.55 
0073684  31,341  $1,159,937  $37.01  318  $9,711  $30.54  $6.47 
0072027  44,149  $1,893,240  $42.88  606  $22,072  $36.42  $6.46 
0011821  108,097  $8,437,090  $78.05  27,577  $2,017,734  $73.17  $4.88 
0069191  2,337  $784,793  $335.81  292  $96,756  $331.36  $4.45 
0039142  10,117  $629,981  $62.27  109  $6,379  $58.53  $3.74 
0072010  20,028  $965,848  $48.22  352  $16,073  $45.66  $2.56 
0090693  93,269  $1,426,941  $15.30  55,032  $717,088  $13.03  $2.27 
0073518  31,117  $1,608,797  $51.70  463  $22,986  $49.65  $2.05 
0076683  13,440  $584,396  $43.48  242  $10,094  $41.71  $1.77 
0033577  23,336  $738,655  $31.65  546  $16,657  $30.51  $1.14 
0041000  55,022  $806,986  $14.67  53,005  $752,081  $14.19  $0.48 
0090113  82,948  $1,262,568  $15.22  28,140  $417,250  $14.83  $0.39 
0072016  76,225  $2,940,408  $38.58  3,715  $142,864  $38.46  $0.12 
0056505  83,809  $1,121,843  $13.39  1,368  $18,299  $13.38  $0.01 
0054184  7,520  $750,018  $99.74  186  $18,600  $100.00  ($0.26) 
0072046  31,818  $1,405,603  $44.18  767  $35,602  $46.42  ($2.24) 
0040349  6,868  $1,402,648  $204.23  2,123  $445,197  $209.70  ($5.47) 
0073448  71,110  $3,695,099  $51.96  2,378  $137,677  $57.90  ($5.94) 
0070079  22,914  $1,124,422  $49.07  420  $23,105  $55.01  ($5.94) 
0072031  16,408  $916,940  $55.88  213  $13,276  $62.33  ($6.45) 
0069185  5,190  $649,339  $125.11  347  $45,745  $131.83  ($6.72) 
0072048  72,910  $3,534,036  $48.47  1,516  $83,859  $55.32  ($6.85)  Page 25  Herb Kuhn 
Table 8: Medical ServicesTop 100 Service Providers by Total Affected Individual Payments - 
continued 
Average 
Number  Average  Total  Payment 
of  Total  Payment Per  Number of  Payments  Per 
Affected  Payments for  Affected  Nonaffected  for  Nonaffected  Difference 
Provider  Individual   Affected  Individual  Individuals  Nonaffected  Individual  in Average 
Number  Services  Individuals  Service  Services  Individuals  Service  Payments 
0094191  95,241  $698,641  $7.34  1,411  $20,332  $14.41  ($7.07) 
0074682  19,488  $1,058,528  $54.32  173  $10,836  $62.64  ($8.32) 
0033814  25,009  $1,048,892  $41.94  139  $7,077  $50.92  ($8.98) 
0076379  22,361  $1,237,514  $55.34  480  $31,351  $65.31  ($9.97) 
0091729  3,406  $890,276  $261.38  93  $25,368  $272.77  ($11.39) 
0074665  46,667  $1,774,130  $38.02  3,739  $187,702  $50.20  ($12.18) 
0072002  55,116  $2,372,728  $43.05  990  $54,767  $55.32  ($12.27) 
0073009  26,692  $1,122,287  $42.05  1,468  $80,855  $55.08  ($13.03) 
0072044  18,637  $932,037  $50.01  1,068  $68,074  $63.74  ($13.73) 
0072043  25,116  $1,292,885  $51.48  520  $34,240  $65.85  ($14.37) 
0094092  14,401  $576,975  $40.06  120  $7,053  $58.78  ($18.72) 
0072042  55,583  $4,050,414  $72.87  6,412  $594,446  $92.71  ($19.84) 
0073456  56,311  $2,509,818  $44.57  822  $53,520  $65.11  ($20.54) 
0035402  10,076  $786,894  $78.10  139  $13,809  $99.35  ($21.25) 
0074870  18,260  $784,470  $42.96  266  $17,607  $66.19  ($23.23) 
0017187  1,020  $865,054  $848.09  20  $17,637  $881.83  ($33.74) 
0092265  2,522  $2,031,238  $805.41  345  $290,374  $841.66  ($36.25) 
0070235  1,394  $635,719  $456.04  40  $20,119  $502.97  ($46.93) 
0053054  3,596  $1,172,835  $326.15  870  $324,673  $373.19  ($47.04) 
0058107  405  $737,622  $1,821.29  20  $37,521  $1,876.06  ($54.77) 
0073035  40,555  $1,942,455  $47.90  1,050  $114,511  $109.06  ($61.16) 
0098837  1,959  $1,972,626  $1,006.96  327  $351,649  $1,075.38  ($68.42) 
0054433  6,414  $899,872  $140.30  151  $32,774  $217.05  ($76.75) 
0072041  20,998  $1,274,252  $60.68  585  $111,353  $190.35  ($129.67) 
0096869  1,695  $857,066  $505.64  52  $34,503  $663.52  ($157.88) 
0018833  824  $695,066  $843.53  173  $178,590  $1,032.31  ($188.78) 
0098420  808  $851,806  $1,054.22  10  $12,516  $1,251.60  ($197.38) 
Source: Contractor analysis of Louisiana Medicaid data, October 1, 2005March 31, 2006.  Page 26  Herb Kuhn 
Medicaid Prescription Drugs 
Total Payments 
Total payments by affected individual status are listed in Table 9.  The average payment per 
affected individual for prescription drug services in the first two quarters of FY 2006 was 
$624.82 compared to an average payment of $720.68 per nonaffected individual for the same 
period. There were nearly twice as many affected individuals as nonaffected individuals. 
Table 9: Prescription DrugsPayments by Beneficiaries Individual Status 
Unique  Average Payment 
Individual Status  Beneficiary Count  Total Payment  per Beneficiary 
Affected individuals  419,665  $262,214,395  $624.82 
Nonaffected individuals  213,001  $153,505,380  $720.68 
   Total  632,666  $415,719,775  $657.09 
Source: OIG analysis of Louisiana Medicaid data, October 1, 2005March 31, 2006. 
Monthly Payments 
Table 10 displays the total and average payment per beneficiary by month.  Beneficiaries are 
only counted once per month if they have any number of prescriptions in that month, but they 
may receive prescriptions in multiple months.  As the table demonstrates, in each month, the 
average payment per affected individual was slightly less than per nonaffected individual.   
Table 10:  Prescription DrugsTotal and Average Payment per Beneficiary by Month 
Affected  Average  Nonaffected  Average 
Individuals  Total Payments  Payment  Individuals  Total Payments for  Payment per 
Receiving  for Affected  per Affected  Receiving  Nonaffected  Nonaffected 
Month  Prescriptions  Individuals  Individual  Prescriptions  Individuals  Individual 
October 2005  205,555  $51,698,771  $251.51               111,970  $30,931,593  $276.25 
November 2005  206,499  $50,569,081  $244.89               112,400  $30,970,966  $275.54 
December 2005  208,266  $52,997,918  $254.47               113,320  $32,361,163  $285.57 
January 2006  186,002  $35,525,508  $191.00  95,320  $19,610,162  $205.73 
February 2006  180,301  $33,299,951  $184.69  94,960  $18,650,108  $196.40 
March 2006  190,508  $38,123,163  $200.11  99,725  $20,981,385  $210.39 
   Total  1,177,131  $262,214,394  $222.76               627,695  $153,505,380   $244.55 
Source: OIG analysis of Louisiana Medicaid data, October 1, 2005March 31, 2006. 
Payment and Beneficiaries by Parish 
Table 11 on the following page displays the total and average payment per beneficiary by 
parish. Of 64 parishes, 20 had greater average payments per affected individual than per 
nonaffected individual. Twelve of the twenty parishes had average payment differences of at 
least $100. However, the three parishes with average differences greater than $100 in 
payments had less than 50 affected individuals who received prescription drugs.  Figures 5 and 
6 on page 30 display the distribution of average payments by parish for affected individuals 
and nonaffected individuals, respectively.  Page 27  Herb Kuhn 
The percentage of beneficiaries located in each parish is also outlined in Table 11.  Three 
parishesEast Baton Rouge, Jefferson, and Orleansaccounted for one-third of the affected 
individuals and just 1 percent of the total nonaffected individual population.  The average 
payments for affected individuals for these three parishes were less than for nonaffected 
individuals. In addition, Figures 7 and 8 on page 31 provide graphical representations of the 
affected individual and nonaffected individual population distribution by parish, respectively.  
Table 11:  Prescription DrugsTotal and Average Payment by Parish  
Average  Total  Average 
Affected  Percentage  Total  Payment  Nonaffected  Percentage  Payments  Payment  Difference 
Individuals  of Total  Payments  per  Individuals  of Total  for  per  in 
Receiving  Affected  for Affected  Affected  Receiving  Nonaffected  Nonaffected  Nonaffected  Average 
Parish  Prescriptions  Individuals  Individuals  Individual  Prescriptions  Individuals  Individuals  Individual  Payments 
Webster  35  0.01%  $57,291  $1,636.89  6,643  3.1%  $4,670,417  $703.06  $933.83 
Bienville  10  0.002%  $11,876  $1,187.58  2,726  1.3%  $1,783,786  $654.36  $533.22 
Plaquemines  3,153  0.8%  $1,956,080  $620.39  31  0.01%  $9,337  $301.18  $319.20 
West 
Feliciana  1,429  0.3%  $1,124,735  $787.08  17  0.01%  $9,121  $536.54  $250.54 
Catahoula  24  0.01%  $21,774  $907.27  2,205  1.0%  $1,463,566  $663.75  $243.52 
Acadia  12,077  2.9%  $9,618,393  $796.42  255  0.1%  $146,468  $574.39  $222.04 
Caddo  335  0.1%  $285,365  $851.84  34,831  16.4%  $22,453,376  $644.64  $207.20 
West Baton 
Rouge  3,232  0.8%  $2,290,415  $708.67  38  0.0%  $21,106  $555.42  $153.25 
Allen  4,441  1.1%  $3,100,533  $698.16  147  0.1%  $80,247  $545.90  $152.26 
Vermilion  8,118  1.9%  $5,205,088  $641.18  147  0.1%  $72,481  $493.07  $148.11 
St. James  3,410  0.8%  $1,346,151  $394.77  32  0.02%  $8,626  $269.55  $125.21 
Sabine  3,816  0.9%  $2,702,379  $708.17  122  0.1%  $72,329  $592.86  $115.31 
Red River  12  0.003%  $7,847  $653.89  1,811  0.9%  $1,013,448  $559.61  $94.29 
Livingston  14,192  3.4%  $8,471,005  $596.89  277  0.1%  $140,520  $507.29  $89.59 
St. Mary  10,924  2.6%  $6,566,531  $601.11  137  0.1%  $71,918  $524.95  $76.16 
St. Helena  1,936  0.5%  $1,072,545  $554.00  24  0.01%  $11,654  $485.57  $68.43 
Lafourche  13,486  3.2%  $7,981,949  $591.87  140  0.1%  $74,001  $528.58  $63.29  Page 28  Herb Kuhn 
Table 11:  Prescription DrugsTotal and Average Payment by Parish - continued 
Average  Total  Average 
Affected  Percentage  Total  Payment  Nonaffected  Percentage  Payments  Payment  Difference 
Individuals  of Total  Payments  per  Individuals  of Total  for  per  in 
Receiving  Affected  for Affected  Affected  Receiving  Nonaffected  Nonaffected  Nonaffected  Average 
Parish  Prescriptions  Individuals  Individuals  Individual  Prescriptions  Individuals  Individuals  Individual  Payments 
East Carroll  22  0.01%  $16,834  $765.19  2,704  1.3%  $1,918,555  $709.52  $55.66 
Calcasieu  24,293  5.8%  $16,441,945  $676.82  455  0.2%  $290,443  $638.34  $38.48 
Lafayette  22,928  5.5%  $16,054,996  $700.24  631  0.3%  $441,617  $699.87  $0.37 
Lincoln  104  0.02%  $67,791  $651.84  5,592  2.6%  $3,660,137  $654.53  ($2.69) 
St. Bernard  5,845  1.4%  $2,938,283  $502.70  56  0.0%  $28,768  $513.72  ($11.02) 
Iberville  6,510  1.6%  $4,000,219  $614.47  86  0.0%  $55,286  $642.86  ($28.38) 
East Baton 
Rouge  53,108  12.7%  $33,311,354  $627.24  880  0.4%  $580,269  $659.40  ($32.16) 
St. Charles  5,485  1.3%  $2,572,099  $468.93  44  0.02%  $22,230  $505.23  ($36.30) 
Washington  8,967  2.1%  $7,488,870  $835.16  220  0.1%  $194,383  $883.56  ($48.40) 
Morehouse  54  0.01%  $40,616  $752.15  6,959  3.3%  $5,589,958  $803.27  ($51.12) 
Rapides  442  0.1%  $309,768  $700.83  21,973  10.3%  $16,542,701  $752.86  ($52.03) 
Ascension  10,830  2.6%  $6,259,251  $577.95  157  0.1%  $99,937  $636.54  ($58.59) 
Tensas  46  0.01%  $22,230  $483.27  1,557  0.7%  $843,685  $541.87  ($58.60) 
Madison  34  0.01%  $17,144  $504.25  3,062  1.4%  $1,763,917  $576.07  ($71.82) 
Jefferson 
Davis  5,989  1.4%  $4,823,773  $805.44  102  0.05%  $90,170  $884.02  ($78.58) 
La Salle  21  0.01%  $12,614  $600.68  2,264  1.1%  $1,538,787  $679.68  ($79.00) 
De Soto  43  0.01%  $24,126  $561.06  4,107  1.9%  $2,668,998  $649.87  ($88.81) 
Concordia  99  0.02%  $48,014  $484.99  4,021  1.9%  $2,324,444  $578.08  ($93.09) 
Bossier  137  0.03%  $72,324  $527.91  10,618  5.0%  $6,645,697  $625.89  ($97.98) 
Union  10  0.002%  $6,434  $643.44  3,799  1.8%  $2,821,927  $742.81  ($99.36) 
Caldwell  24  0.01%  $17,032  $709.66  2,133  1.0%  $1,733,565  $812.74  ($103.08) 
Beauregard  4,803  1.1%  $3,154,408  $656.76  99  0.05%  $75,787  $765.52  ($108.77) 
Vernon  5,670  1.4%  $3,477,615  $613.34  148  0.1%  $107,488  $726.27  ($112.94) 
St. Landry  562  0.1%  $405,476  $721.49  19,415  9.1%  $16,275,026  $838.27  ($116.78) 
Avoyelles  210  0.1%  $120,500  $573.81  9,510  4.5%  $6,568,153  $690.66  ($116.85) 
Tangipahoa  20,616  4.9%  $13,150,761  $637.89  366  0.2%  $279,827  $764.55  ($126.66)  Page 29  Herb Kuhn 
Table 11:  Prescription Drugs  Total and Average Payment by Parish - continued 
Average  Total  Average 
Affected  Percentage  Total  Payment  Nonaffected  Percentage  Payments  Payment  Difference 
Individuals  of Total  Payments  per  Individuals  of Total  for  per  in 
Receiving  Affected  for Affected  Affected  Receiving  Nonaffected  Nonaffected  Nonaffected  Average 
Parish  Prescriptions  Individuals  Individuals  Individual  Prescriptions  Individuals  Individuals  Individual  Payments 
Grant  49  0.01%  $26,026  $531.14  3,363  1.6%  $2,217,753  $659.46  ($128.32) 
Iberia  14,292  3.4%  $8,764,298  $613.23  159  0.1%  $117,956  $741.86  ($128.63) 
Evangeline  211  0.1%  $149,023  $706.27  8,816  4.1%  $7,543,805  $855.69  ($149.43) 
Jefferson  48,200  11.5%  $27,383,822  $568.13  616  0.3%  $455,117  $738.83  ($170.70) 
Jackson  24  0.01%  $13,478  $561.57  2,536  1.2%  $1,857,871  $732.60  ($171.03) 
Ouachita  314  0.1%  $160,618  $511.52  22,204  10.4%  $15,195,209  $684.35  ($172.82) 
Winn  26  0.0%  $12,474  $479.76  2,763  1.3%  $1,814,892  $656.86  ($177.10) 
St. Martin  8,392  2.0%  $5,209,810  $620.81  126  0.1%  $102,197  $811.09  ($190.28) 
Claiborne  22  0.01%  $10,452  $475.10  3,000  1.4%  $2,165,270  $721.76  ($246.66) 
Assumption  3,957  0.9%  $2,528,413  $638.97  35  0.02%  $31,981  $913.75  ($274.78) 
Terrebonne  17,501  4.2%  $10,966,925  $626.65  259  0.1%  $233,852  $902.90  ($276.26) 
West Carroll  36  0.0%  $18,216  $506.00  2,870  1.3%  $2,349,219  $818.54  ($312.54) 
St. John 
the Baptist  6,946  1.7%  $2,816,321  $405.46  92  0.0%  $66,890  $727.07  ($321.61) 
Natchitoches  130  0.03%  $57,203  $440.03  7,011  3.3%  $5,395,283  $769.55  ($329.52) 
Cameron  817  0.2%  $403,721  $494.15  11  0.01%  $9,337  $848.78  ($354.63) 
Franklin  52  0.0%  $20,508  $394.39  5,214  2.4%  $3,919,878  $751.80  ($357.41) 
Orleans  41,076  9.8%  $19,754,129  $480.92  551  0.3%  $471,537  $855.78  ($374.87) 
Pointe 
Coupee  4,088  1.0%  $2,431,839  $594.87  45  0.02%  $45,995  $1,022.10  ($427.23) 
East 
Feliciana  3,155  0.8%  $2,206,080  $699.23  49  0.02%  $55,471  $1,132.05  ($432.82) 
St. 
Tammany  19,725  4.7%  $12,600,380  $638.80  416  0.2%  $448,304  $1,077.65  ($438.85) 
Richland  21  0.01%  $6,224  $296.36  4,759  2.2%  $3,743,406  $786.60  ($490.23) 
Total  426,516  100.0%  $262,214,395  $614.78  215,436  100.0%  $153,505,380  $712.53  ($97.75) 
Source: OIG analysis of Louisiana Medicaid data, October 1, 2005March 31, 2006.  Page 30  Herb Kuhn 
Figure 5:  Prescription DrugsAverage Payment by Parish for 
Affected Individuals 
Figure 6:  Prescription DrugsAverage Payment by Parish for 
Nonaffected Individuals  Page 31  Herb Kuhn 
Figure 7:  Prescription DrugsAffected Individual Distribution 
by Parish 
Figure 8:  Prescription DrugsNonaffected Individual 
Distribution by Parish  Page 32  Herb Kuhn 
Payments by Eligibility Category 
Tables 12a and 12b summarize total and average payments by eligibility category.  These 
tables differ by the unit of analysis. Table 12a lists the total average payments per 
beneficiary within each eligibility category.  Because beneficiaries may have more than 
one reason for eligibility, they may be counted in more than one eligibility category.   
Table 12b on the following page displays the total and average payments per prescription 
within each eligibility category. 
Table 12a shows that in 5 of the 20 eligibility categories, the average payment per 
affected individual was greater than that per nonaffected individual, but only two 
categories had differences greater than $20. The two categories with average differences 
greater than $20 were blind/disabled, poverty and other adult. 
There are 12 categories in Table 12b in which the average payment per prescription was 
greater for affected individuals than for nonaffected individuals.  However, none of these 
12 categories had payment differences greater than $10. 
Table 12a: Prescription DrugsTotal and Average Payments per Beneficiary by Eligibility Category 
Average  Average 
 Affected  Payment  Nonaffected  Total  Payment 
Individuals  Total Payments  per  Individuals  Payments for  per  Difference 
Eligibility Category  Receiving  for Affected  Affected  Receiving  Nonaffected  Nonaffected  in Average 
and Description Prescriptions  Individuals  Individual  Prescriptions  Individuals  Individual  Payments 
32 - Blind/disabled, 
poverty  794  $176,852  $222.74  371  $70,842  $190.95  $31.79 
45 - Other adult  4,526  $1,526,283  $337.23  1,357  $420,169  $309.63  $27.59 
35 - Adult, poverty  22,856  $5,003,049  $218.89  9,766  $2,020,829  $206.93  $11.97 
15 - AFDC adult, 
cash  25,744  $12,054,811  $468.26  11,256  $5,169,316  $459.25  $9.01 
21 - Aged, MN  584  $720,729  $1,234.13  426  $521,923  $1,225.17  $8.95 
31 - Aged, poverty  1,381  $128,919  $93.35  1,030  $101,181  $98.23  ($4.88) 
34 - Child, poverty  194,332  $59,080,882  $304.02  90,603  $28,077,356  $309.89  ($5.87) 
25 - AFDC adult, MN  2,658  $1,385,928  $521.42  1,247  $671,051  $538.13  ($16.72) 
14 - AFDC child, 
cash  32,224  $8,682,603  $269.45  19,392  $6,069,698  $313.00  ($43.55) 
17 - AFDC-U adult, 
cash  4,016  $2,342,923  $583.40  1,323  $834,507  $630.77  ($47.37) 
16 - AFDC-U child, 
cash  2,672  $790,988  $296.03  1,252  $482,255  $385.19  ($89.16) 
12 - Blind/disabled, 
cash  68,200  $106,245,937  $1,557.86  35,943  $59,534,811  $1,656.37  ($98.51) 
42 - Other 
blind/disabled  9,765  $14,477,035  $1,482.54  4,492  $7,139,928  $1,589.48  ($106.93) 
44 - Other child  28,584  $11,586,348  $405.34  13,853  $7,173,434  $517.83  ($112.48) 
11 - Aged, cash  19,190  $17,902,840  $932.93  13,264  $14,403,132  $1,085.88  ($152.96) 
41 - Other aged  12,072  $17,326,598  $1,435.27  9,019  $14,389,549  $1,595.47  ($160.20) 
48 - Foster care 
child  1,407  $954,773  $678.59  5,556  $5,119,554  $921.45  ($242.86)  Page 33  Herb Kuhn 
Table 12a: Prescription DrugsTotal and Average Payments per Beneficiary by Eligibility Category 
continued 
Average  Average 
Affected  Payment  Nonaffected  Payment 
Individuals  Total Payments  per  Individuals  Total Payments  per  Difference 
Eligibility Category and  Receiving  for Affected  Affected  Receiving  for Nonaffected  Nonaffected  in Average 
Description  Prescriptions  Individuals  Individual  Prescriptions  Individuals  Individual  Payments 
24 - AFDC child, MN  287  $54,401  $189.55  171  $91,826  $537.00  ($347.44) 
22 - Blind/disabled, MN  641  $749,667  $1,169.53  274  $460,177  $1,679.48  ($509.95) 
3A - Individual covered under 
the Breast and Cervical Cancer 
Prevention Act of 2000, poverty  518  $1,022,819  $1,974.56  271  $753,834  $2,781.68  ($807.12) 
      Total  432,451  $262,214,394  $606.34  220,866  $153,505,380  $695.02  ($88.68) 
Source: OIG analysis of Louisiana Medicaid data, October 1, 2005March 31, 2006. 
Table 12b:  Prescription DrugsTotal and Average Payments per Prescription by Eligibility Category 
Average 
Average  Payment 
Number of  Payment  Number of  Total  per 
Affected  Total Payments  per Affected  Nonaffected  Payments for  Nonaffected  Difference 
Eligibility Category and  Individual  for Affected  Individual  Individual  Nonaffected  Individual  in Average 
Description  Prescriptions  Individuals  Prescription  Prescriptions  Individuals  Prescription  Payments 
32 - Blind/disabled, poverty  5,100  $176,852  $34.68  2,633  $70,842  $26.91  $7.77 
45 - Other adult  29,498  $1,526,283  $51.74  9,421  $420,169  $44.60  $7.14 
15 - AFDC adult, cash  234,298  $12,054,811  $51.45  109,281  $5,169,316  $47.30  $4.15 
12 - Blind/disabled, cash  1,266,925  $106,245,937  $83.86  736,384  $59,534,811  $80.85  $3.01 
34 - Child, poverty  1,025,081  $59,080,882  $57.64  509,892  $28,077,356  $55.07  $2.57 
21 - Aged, MN  12,775  $720,729  $56.42  9,654  $521,923  $54.06  $2.35 
31 - Aged, poverty  6,726  $128,919  $19.17  5,937  $101,181  $17.04  $2.12 
35 - Adult, poverty  124,372  $5,003,049  $40.23  52,124  $2,020,829  $38.77  $1.46 
17 - AFDC-U adult, cash  41,340  $2,342,923  $56.67  15,069  $834,507  $55.38  $1.30 
25 - AFDC adult, MN  24,345  $1,385,928  $56.93  12,036  $671,051  $55.75  $1.18 
42 - Other blind/disabled  185,327  $14,477,035  $78.12  92,421  $7,139,928  $77.25  $0.86 
11 - Aged, cash  313,301  $17,902,840  $57.14  253,775  $14,403,132  $56.76  $0.39 
14 - AFDC child, cash  157,053  $8,682,603  $55.28  104,814  $6,069,698  $57.91  ($2.62) 
41 - Other aged  288,548  $17,326,598  $60.05  226,784  $14,389,549  $63.45  ($3.40)  Page 34  Herb Kuhn 
Table 12b:  Prescription DrugsTotal and Average Payments per Prescription by Eligibility Category - continued 
Average 
Average  Payment 
Number of  Total  Payment  Number of  Total  per 
Affected  Payments for  per Affected  Nonaffected  Payments for  Nonaffected  Difference in 
Eligibility Category and  Individual  Affected  Individual  Individual  Nonaffected  Individual  Average 
Description  Prescriptions  Individuals  Prescription  Prescriptions  Individuals  Prescription  Payments 
16 - AFDC-U Child, cash  13,770  $790,988  $57.44  7,488  $482,255  $64.40  ($6.96) 
48 - Foster care child  10,537  $954,773  $90.61  51,785  $5,119,554  $98.86  ($8.25) 
44 - Other child  161,596  $11,586,348  $71.70  82,410  $7,173,434  $87.05  ($15.35) 
22 - Blind/disabled, MN  8,498  $749,667  $88.22  3,879  $460,177  $118.63  ($30.42) 
24 - AFDC child, MN  1,232  $54,401  $44.16  952  $91,826  $96.46  ($52.30) 
3A -  Individual covered under 
the Breast and Cervical 
Cancer Prevention Act of 
2000, poverty  9,535  $1,022,819  $107.27  4,651  $753,834  $162.08  ($54.81) 
Total  3,919,857  $262,214,394  $66.89  2,291,390  $153,505,380   $66.99  ($0.10) 
Source: OIG analysis of Louisiana Medicaid data, October 1, 2005March 31, 2006. 
Payment by Standard Therapeutic Classification 
Tables 13a and 13b on the following pages summarize total and average payment by 
standard therapeutic classification (STC).12  These tables differ by the unit of analysis. 
Table 13a lists the total average payments per beneficiary within each STC.  Because 
beneficiaries may have more than one prescription, they may be counted in more than 
one STC. Table 13b displays the total and average payments per prescription within each 
STC. 
In Table 13a, there are 39 of 92 STCs in which the average payment per affected 
individual was greater than per nonaffected individual.  Twelve of the STCs were greater 
by more than $20 and one was greater by more than $100.  The STC that had an average 
payment per affected individual more than $100 greater than that of nonaffected 
individuals was anabolics. Anabolics, also known as steroids, are synthetic substances 
similar to the male sex hormone testosterone. 
In 58 of 94 STCs in Table 13b, the average payment per prescription was greater for 
affected individuals than for nonaffected individuals.  Nine of the fifty-eight STCs were 
greater by more than $20 and just oneantidoteswas greater by more than $100.  
Antidotes either prevent a poison from working or reverse the effects of a poison. 
12 The STC system groups National Drug Codes according to their most commonly intended use.  Each 
National Drug Code is assigned by the Food and Drug Administration and is a three-part universal 
identifier that specifies the drugs manufacturer, name, dosage form, strength, and package size.  Page 35  Herb Kuhn 
Table 13a:  Prescription DrugsTotal and Average Payments per Beneficiary by STC 
Average  Average 
Affected  Total  Payment  Nonaffected  Payment 
Individuals  Payments for  per  Individuals  Total Payments  per  Difference in 
Receiving  Affected  Affected  Receiving  for Nonaffected  Nonaffected  Average 
STC  Prescriptions  Individuals  Individual  Prescriptions  Individuals  Individual  Payments 
Anabolics  161  $156,769  $973.73  76  $66,006  $868.51  $105.21 
Antineoplastics  2,637  $1,841,965  $698.51  1,650  $995,361  $603.25  $95.26 
Other hormones  3,414  $2,996,262  $877.64  1,685  $1,361,213  $807.84  $69.80 
Bile therapy  141  $55,333  $392.43  78  $25,211  $323.23  $69.21 
General antibacterials 
and antiseptics  759  $89,224  $117.56  1,070  $55,149  $51.54  $66.01 
Xanthine derivatives  1,194  $206,911  $173.29  808  $96,547  $119.49  $53.80 
Anesthetic local topical  6,822  $726,961  $106.56  3,683  $235,882  $64.05  $42.51 
Enzymes  2,746  $732,637  $266.80  1,388  $327,584  $236.01  $30.79 
Nonnarcotic analgesics  11,058  $1,657,279  $149.87  6,899  $824,522  $119.51  $30.36 
Contraceptives, 
nonsystemic  8  $396  $49.56  13  $257  $19.79  $29.77 
Anticonvulsants  29,147  $13,870,910  $475.89  16,284  $7,396,042  $454.19  $21.70 
Narcotic analgesics  95,047  $9,471,657  $99.65  55,059  $4,381,093  $79.57  $20.08 
Antinauseants  20,385  $2,181,278  $107.00  12,192  $1,068,193  $87.61  $19.39 
Rauwolfias  39  $3,117  $79.94  16  $990  $61.90  $18.04 
Adrenergics  2,467  $165,445  $67.06  2,135  $106,989  $50.11  $16.95 
Hemorrhoidal preparations  326  $34,436  $105.63  218  $19,680  $90.28  $15.36 
Glucocorticoids  80,356  $6,981,556  $86.88  38,711  $2,920,528  $75.44  $11.44 
Vasodilators peripheral  40  $3,554  $88.86  76  $5,955  $78.36  $10.50 
Tetracyclines  11,432  $452,929  $39.62  5,498  $160,387  $29.17  $10.45 
Mineralocorticoids  213  $19,542  $91.75  235  $19,153  $81.50  $10.25 
Progesterone  1,597  $59,943  $37.54  699  $19,996  $28.61  $8.93 
All other dermatologicals  14,579  $2,742,410  $188.11  6,899  $1,239,888  $179.72  $8.39 
Vitamin K  152  $4,655  $30.63  183  $4,136  $22.60  $8.02 
Antimalarials  1,760  $145,174  $82.49  1,237  $92,367  $74.67  $7.81  Page 36  Herb Kuhn 
Table 13a:  Prescription DrugsTotal and Average Payments per Beneficiary by STC - continued 
Average  Average 
Affected  Total  Payment  Nonaffected  Payment 
Individuals  Payments for  per  Individuals  Total Payments  per  Difference 
Receiving  Affected  Affected  Receiving  for Nonaffected  Nonaffected  in Average 
STC  Prescriptions  Individuals  Individual  Prescriptions  Individuals  Individual  Payments 
Electrolytes and
 miscellaneous nutrients  15,853  $1,393,967  $87.93  12,052  $973,379  $80.76  $7.17 
Antidotes  157  $380,969  $2,426.56  60  $145,193  $2,419.89  $6.67 
CNS stimulants  15,454  $5,293,673  $342.54  6,642  $2,234,860  $336.47  $6.07 
B complex with vitamin C  113  $4,201  $37.18  47  $1,500  $31.94  $5.25 
Antiparasitics  16,918  $908,866  $53.72  8,226  $416,210  $50.60  $3.12 
Other antibiotics  37,326  $2,643,595  $70.82  17,424  $1,186,975  $68.12  $2.70 
Multivitamins  29,095  $1,124,873  $38.66  15,378  $558,585  $36.32  $2.34 
  Cough preparations/         
   expectorants  19,982  $500,719  $25.06  15,993  $372,240  $23.28  $1.78 
Antidiarrheals  4,495  $80,330  $17.87  2,680  $43,491  $16.23  $1.64 
Emollients/protectives  1,257  $71,475  $56.86  549  $30,558  $55.66  $1.20 
Oxytocics  670  $9,891  $14.76  159  $2,178  $13.70  $1.06 
Folic acid preparations  3,890  $109,320  $28.10  2,380  $64,386  $27.05  $1.05 
Cephalosporins  77,005  $6,740,462  $87.53  41,875  $3,642,306  $86.98  $0.55 
Thyroid preparations  10,063  $467,029  $46.41  6,023  $278,173  $46.19  $0.23 
Sulfonamides  36,283  $618,001  $17.03  16,561  $281,400  $16.99  $0.04 
Iodine therapy  24  $510  $21.29  2  $43  $21.82  ($0.53) 
Cold and cough 
    preparations  9,560  $239,841  $25.09  6,371  $163,469  $25.66  ($0.57) 
Erythromycins  79,077  $4,695,801  $59.38  43,874  $2,632,572  $60.00  ($0.62) 
Digitalis preparations  4,164  $126,643  $30.41  3,077  $95,521  $31.04  ($0.63) 
Sedative barbiturate  2,448  $102,322  $41.80  1,788  $76,006  $42.51  ($0.71) 
Muscle relaxants  23,470  $2,417,410  $103.00  10,918  $1,133,024  $103.78  ($0.78) 
Systemic contraceptives  23,335  $2,747,237  $117.73  10,645  $1,265,663  $118.90  ($1.17) 
Vasodilators coronary  7,299  $589,123  $80.71  4,972  $408,720  $82.20  ($1.49) 
Topical nasal and 
   otic preparations  55,288  $5,170,067  $93.51  27,846  $2,654,272  $95.32  ($1.81) 
Penicillins  117,401  $4,536,108  $38.64  56,923  $2,315,780  $40.68  ($2.04) 
Fungicides  49,975  $3,311,212  $66.26  27,448  $1,880,136  $68.50  ($2.24)  Page 37  Herb Kuhn 
Table 13a:  Prescription DrugsTotal and Average Payments per Beneficiary by STC - continued 
Average  Average 
Affected  Total  Payment  Nonaffected  Payment 
Individuals  Payments for  per  Individuals  Total Payments  per  Difference 
Receiving  Affected  Affected  Receiving  for Nonaffected  Nonaffected  in Average 
STC  Prescriptions  Individuals  Individual  Prescriptions  Individuals  Individual  Payments 
Antihistamines  103,407  $6,332,833  $61.24  61,557  $3,909,991  $63.52  ($2.28) 
Water-soluble vitamins  4,927  $307,214  $62.35  3,280  $214,308  $65.34  ($2.98) 
Diuretics  30,595  $925,705  $30.26  19,074  $635,099  $33.30  ($3.04) 
Antispasmodic and  
anticholinergic agents  13,072  $1,554,991  $118.96  8,140  $993,784  $122.09  ($3.13) 
Laxatives  10,475  $535,944  $51.16  6,212  $337,838  $54.38  ($3.22) 
Vaginal cleansers  60  $1,887  $31.46  48  $1,671  $34.83  ($3.37) 
Medical supplies  14,051  $649,832  $46.25  6,781  $339,327  $50.04  ($3.79) 
Estrogens  6,151  $659,117  $107.16  3,565  $395,705  $111.00  ($3.84) 
Urinary antibacterials  14,200  $1,162,672  $81.88  8,853  $760,152  $85.86  ($3.99) 
Antithyroid preparations  448  $34,591  $77.21  247  $20,078  $81.29  ($4.07) 
Parasympathetic agents  4,412  $1,714,436  $388.58  3,553  $1,395,377  $392.73  ($4.15) 
Aldosterone antagonists  2,390  $146,190  $61.17  1,263  $82,947  $65.67  ($4.51) 
Trimethoprim  99  $5,366  $54.21  110  $6,584  $59.86  ($5.65) 
Antiparkinson  5,323  $654,760  $123.01  3,360  $435,737  $129.68  ($6.68) 
Miscellaneous  101,907  $14,302,285  $140.35  59,778  $8,834,871  $147.79  ($7.45) 
Androgens  224  $63,009  $281.29  86  $24,912  $289.68  ($8.39) 
Ophthalmic preparations  32,431  $2,015,558  $62.15  15,533  $1,106,547  $71.24  ($9.09) 
Other hypotensives  47,368  $7,305,240  $154.22  27,618  $4,520,466  $163.68  ($9.46) 
Fat-soluble vitamins  397  $53,528  $134.83  226  $33,106  $146.49  ($11.66) 
Amphetamine preparations  13,707  $5,095,207  $371.72  5,001  $1,917,625  $383.45  ($11.73) 
Antiarthritics  65,528  $4,635,871  $70.75  38,227  $3,214,408  $84.09  ($13.34) 
Sedative nonbarbiturate  13,635  $2,355,454  $172.75  7,073  $1,319,026  $186.49  ($13.74) 
Lipotropics  25,445  $7,912,658  $310.97  13,959  $4,538,132  $325.10  ($14.13) 
Tuberculosis preparations  1,334  $68,800  $51.57  411  $27,622  $67.21  ($15.63) 
Psychostimulants- 
   antidepressants  52,039  $14,949,970  $287.28  29,324  $8,925,752  $304.38  ($17.10) 
Bronchial dilators  84,529  $15,086,752  $178.48  43,863  $8,620,328  $196.53  ($18.05)  Page 38  Herb Kuhn 
Table 13a:  Prescription DrugsTotal and Average Payments per Beneficiary by STC - continued 
Average  Average 
Affected  Total  Payment  Nonaffected  Payment 
Individuals  Payments for  per  Individuals  Total Payments  per  Difference 
Receiving  Affected  Affected  Receiving  for Nonaffected  Nonaffected  in Average 
STC  Prescriptions  Individuals  Individual  Prescriptions  Individuals  Individual  Payments 
Anticoagulants  13,683  $4,185,715  $305.91  8,925  $2,905,031  $325.49  ($19.59) 
Diabetic therapy  24,597  $8,593,287  $349.36  13,506  $5,012,283  $371.12  ($21.75) 
Diagnostics  7,000  $1,544,604  $220.66  3,513  $854,020  $243.10  ($22.45) 
Antiulcer preparations/   
gastrointestinal 
preparations  42,865  $13,004,284  $303.38  28,343  $9,248,873  $326.32  ($22.94) 
Other cardiovascular 
preparations  37,876  $5,451,759  $143.94  22,507  $3,867,618  $171.84  ($27.90) 
Ataractics-tranquilizers  41,314  $21,923,521  $530.66  21,576  $12,260,774  $568.26  ($37.60) 
All other antiobesity 
preparations  1,173  $370,332  $315.71  602  $214,875  $356.94  ($41.22) 
Other  14,783  $2,800,435  $189.44  9,404  $2,212,914  $235.32  ($45.88) 
Cholesterol reducers  654  $75,559  $115.53  378  $62,253  $164.69  ($49.16) 
Streptomycins  429  $465,778  $1,085.73  216  $248,213  $1,149.14  ($63.41) 
Hematinics and 
    blood cell stimulators  20,206  $3,558,974  $176.13  11,148  $2,954,834  $265.06  ($88.92) 
Protein lysates  89  $282,430  $3,173.37  75  $258,090  $3,441.20  ($267.83) 
Hemostatics  20  $9,886  $494.33  9  $6,982  $775.87  ($281.54) 
Antivirals  12,597  $22,044,737  $1,750.00  7,109  $15,625,395  $2,197.97  ($447.97) 
Corticotropins  4  $9,241  $2,310.45  3  $14,115  $4,705.16  ($2,394.71) 
Biologicals  180  $479,763  $2,665.35  126  $867,902  $6,888.11  ($4,222.76) 
Source: OIG analysis of Louisiana Medicaid data, October 1, 2005March 31, 2006.  Page 39  Herb Kuhn 
Table 13b:  Prescription DrugsTotal and Average Payments per Prescription by STC 
Average 
Average  Payment 
Number of  Total  Payment  Number of  Total  per 
Affected  Payments for  per Affected  Nonaffected  Payments for  Nonaffected  Difference 
Individual  Affected  Individual  Individual  Nonaffected  Individual  in Average 
STC  Prescriptions  Individuals  Prescription  Prescriptions  Individuals  Prescription  Payments 
Antidotes  1,000  $380,969  $380.97  596  $145,193  $243.61  $137.36 
Anabolics  357  $156,769  $439.13  188  $66,006  $351.10  $88.03 
Other hormones  7,995  $2,996,262  $374.77  4,132  $1,361,213  $329.43  $45.33 
General antibacterials and  
antiseptics  1,132  $89,224  $78.82  1,636  $55,149  $33.71  $45.11 
Coal tar  4  $169  $42.34  0  $0.00  $0.00  $42.34 
Anesthetic local topical  9,354  $726,961  $77.72  4,723  $235,882  $49.94  $27.77 
Bile therapy  369  $55,333  $149.95  204  $25,211  $123.59  $26.37 
Contraceptives, nonsystemic  10  $396  $39.65  17  $257  $15.14  $24.51 
Antineoplastics  7,652  $1,841,965  $240.72  4,550  $995,361  $218.76  $21.96 
Xanthine derivatives  3,296  $206,911  $62.78  2,228  $96,547  $43.33  $19.44 
Antinauseants  31,215  $2,181,278  $69.88  20,293  $1,068,193  $52.64  $17.24 
Hemorrhoidal preparations  427  $34,436  $80.65  310  $19,680  $63.48  $17.16 
Adrenergics  2,900  $165,445  $57.05  2,594  $106,989  $41.25  $15.80 
Anesthetics general inject  1  $13  $13.52  0  $0.00  $0.00  $13.52 
Nonnarcotic analgesics  21,653  $1,657,279  $76.54  13,065  $824,522  $63.11  $13.43 
Enzymes  6,409  $732,637  $114.31  3,178  $327,584  $103.08  $11.23 
Anticonvulsants  126,077  $13,870,910  $110.02  73,049  $7,396,042  $101.25  $8.77 
All other dermatologicals  21,061  $2,742,410  $130.21  10,175  $1,239,888  $121.86  $8.36 
Tetracyclines  14,975  $452,929  $30.25  7,123  $160,387  $22.52  $7.73 
Progesterone  2,383  $59,943  $25.15  1,127  $19,996  $17.74  $7.41 
Glucocorticoids  138,595  $6,981,556  $50.37  67,701  $2,920,528  $43.14  $7.24 
Narcotic analgesics  245,017  $9,471,657  $38.66  139,127  $4,381,093  $31.49  $7.17 
Vasodilators peripheral  98  $3,554  $36.27  200  $5,955  $29.78  $6.49 
Emollients protectives  1,639  $71,475  $43.61  768  $30,558  $39.79  $3.82 
Antimalarials  4,169  $145,174  $34.82  2,976  $92,367  $31.04  $3.78 
Electrolytes and miscellaneous  
nutrients  44,561  $1,393,967  $31.28  35,081  $973,379  $27.75  $3.54  Page 40  Herb Kuhn 
Table 13b:  Prescription DrugsTotal and Average Payments per Prescription by STC - continued 
Average 
Average  Payment 
Number of  Total  Payment  Number of  Total  per 
Affected  Payments for  per Affected  Nonaffected  Payments for  Nonaffected  Difference 
Individual  Affected  Individual  Individual  Nonaffected  Individual  in Average 
STC  Prescriptions  Individuals  Prescription  Prescriptions  Individuals  Prescription  Payments 
Multivitamins  44,409  $1,124,873  $25.33  25,500  $558,585  $21.91  $3.42 
Rauwolfias  130  $3,117  $23.98  48  $990  $20.63  $3.35 
Vitamin K  262  $4,655  $17.77  284  $4,136  $14.57  $3.20 
Other  60,333  $2,800,435  $46.42  51,045  $2,212,914  $43.35  $3.06 
Sedative nonbarbiturate  34,638  $2,355,454  $68.00  20,304  $1,319,026  $64.96  $3.04 
Mineralocorticoids  626  $19,542  $31.22  676  $19,153  $28.33  $2.89 
CNS stimulants  55,733  $5,293,673  $94.98  24,208  $2,234,860  $92.32  $2.66 
Amphetamine preparations  48,795  $5,095,207  $104.42  18,844  $1,917,625  $101.76  $2.66 
Antithyroid preparations  1,110  $34,591  $31.16  704  $20,078  $28.52  $2.64 
Other antibiotics  46,977  $2,643,595  $56.27  22,096  $1,186,975  $53.72  $2.56 
Antiparasitics  20,595  $908,866  $44.13  9,883  $416,210  $42.11  $2.02 
Cough preparations/expectorants  25,530  $500,719  $19.61  20,820  $372,240  $17.88  $1.73 
Erythromycins  100,929  $4,695,801  $46.53  58,729  $2,632,572  $44.83  $1.70 
Parasympathetic agents  11,826  $1,714,436  $144.97  9,739  $1,395,377  $143.28  $1.69 
Antidiarrheals  5,968  $80,330  $13.46  3,660  $43,491  $11.88  $1.58 
Topical nasal and otic preparations  81,152  $5,170,067  $63.71  42,715  $2,654,272  $62.14  $1.57 
Miscellaneous  176,923  $14,302,285  $80.84  111,261  $8,834,871  $79.41  $1.43 
Bronchial dilators  214,965  $15,086,752  $70.18  125,052  $8,620,328  $68.93  $1.25 
Cephalosporins  109,143  $6,740,462  $61.76  60,123  $3,642,306  $60.58  $1.18 
Water-soluble vitamins  14,603  $307,214  $21.04  10,786  $214,308  $19.87  $1.17 
Antihistamines  192,196  $6,332,833  $32.95  122,528  $3,909,991  $31.91  $1.04 
Vasodilators coronary  19,174  $589,123  $30.73  13,682  $408,720  $29.87  $0.85 
Medical supplies  25,322  $649,832  $25.66  13,633  $339,327  $24.89  $0.77 
B complex with vitamin C  369  $4,201  $11.39  139  $1,500  $10.80  $0.59 
Oxytocics  717  $9,891  $13.80  164  $2,178  $13.28  $0.51 
Systemic contraceptives  60,961  $2,747,237  $45.07  28,396  $1,265,663  $44.57  $0.49 
Thyroid preparations  31,866  $467,029  $14.66  19,505  $278,173  $14.26  $0.39  Page 41  Herb Kuhn 
Table 13b:  Prescription DrugsTotal and Average Payments per Prescription by STC - continued 
Average 
Average  Total  Payment 
Number of  Total  Payment  Number of  Payments  per 
Affected  Payments for  per Affected  Nonaffected  for  Nonaffected  Difference 
Individual  Affected  Individual  Individual  Nonaffected  Individual  in Average 
STC  Prescriptions  Individuals  Prescription  Prescriptions  Individuals  Prescription  Payments 
Other hypotensives  161,684  $7,305,240  $45.18  100,886  $4,520,466  $44.81  $0.37 
Estrogens  17,171  $659,117  $38.39  10,393  $395,705  $38.07  $0.31 
Folic acid preparations  12,143  $109,320  $9.00  7,356  $64,386  $8.75  $0.25 
Sulfonamides  44,771  $618,001  $13.80  20,536  $281,400  $13.70  $0.10 
Sedative barbiturate  11,037  $102,322  $9.27  8,249  $76,006  $9.21  $0.06 
Cold and cough preparations  12,720  $239,841  $18.86  8,648  $163,469  $18.90  ($0.05) 
Digitalis preparations  11,761  $126,643  $10.77  8,729  $95,521  $10.94  ($0.17) 
Aldosterone antagonists  6,199  $146,190  $23.58  3,485  $82,947  $23.80  ($0.22) 
Fungicides  78,930  $3,311,212  $41.95  44,335  $1,880,136  $42.41  ($0.46) 
Diagnostics  15,915  $1,544,604  $97.05  8,757  $854,020  $97.52  ($0.47) 
Laxatives  17,866  $535,944  $30.00  11,083  $337,838  $30.48  ($0.48) 
Diabetic therapy  116,675  $8,593,287  $73.65  67,569  $5,012,283  $74.18  ($0.53) 
Diuretics  84,463  $925,705  $10.96  55,272  $635,099  $11.49  ($0.53) 
Fat-soluble vitamins  1,030  $53,528  $51.97  630  $33,106  $52.55  ($0.58) 
Penicillins  160,904  $4,536,108  $28.19  80,285  $2,315,780  $28.84  ($0.65) 
Vaginal cleansers  73  $1,887  $25.86  63  $1,671  $26.54  ($0.68) 
Trimethoprim  235  $5,366  $22.84  278  $6,584  $23.68  ($0.85) 
Psychostimulants-antidepressants  183,374  $14,949,970  $81.53  108,159  $8,925,752  $82.52  ($1.00) 
Urinary antibacterials  19,881  $1,162,672  $58.48  12,707  $760,152  $59.82  ($1.34) 
Iodine therapy  39  $510  $13.10  3  $43  $14.54  ($1.44) 
Muscle relaxants  62,576  $2,417,410  $38.63  28,167  $1,133,024  $40.23  ($1.59) 
Antispasmodic and anticholinergic 
agents  26,891  $1,554,991  $57.83  16,710  $993,784  $59.47  ($1.65) 
All other antiobesity preparations  2,112  $370,332  $175.35  1,214  $214,875  $177.00  ($1.65) 
Ophthalmic preparations  49,085  $2,015,558  $41.06  25,842  $1,106,547  $42.82  ($1.76) 
Antiparkinson  16,742  $654,760  $39.11  10,508  $435,737  $41.47  ($2.36) 
Antiulcer preparations/ 
gastrointestinal preparations  110,200  $13,004,284  $118.01  76,748  $9,248,873  $120.51  (2.50) 
Lipotropics  79,372  $7,912,658  $99.69  44,074  $4,538,132  $102.97  ($3.28)  Page 42  Herb Kuhn 
Table 13b:  Prescription DrugsTotal and Average Payments per Prescription by STC - continued 
Average 
Average  Payment 
Number of  Total  Payment  Number of  Total  per 
Affected  Payments for  per Affected  Nonaffected  Payments for  Nonaffected  Difference in 
Individual  Affected  Individual  Individual  Nonaffected  Individual  Average 
STC  Prescriptions  Individuals  Prescription  Prescriptions  Individuals  Prescription  Payments 
Tuberculosis preparations  1,716  $68,800  $40.09  623  $27,622  $44.34  ($4.24) 
Antiarthritics  108,342  $4,635,871  $42.79  67,918  $3,214,408  $47.33  ($4.54) 
Anticoagulants  43,896  $4,185,715  $95.36  29,079  $2,905,031  $99.90  ($4.55) 
Ataractics-tranquilizers  171,416  $21,923,521  $127.90  92,489  $12,260,774  $132.56  ($4.67) 
Other cardiovascular 
preparations  126,469  $5,451,759  $43.11  78,728  $3,867,618  $49.13  ($6.02) 
Androgens  424  $63,009  $148.61  154  $24,912  $161.77  ($13.16) 
Cholesterol reducers  1,127  $75,559  $67.04  739  $62,253  $84.24  ($17.19) 
Protein lysates  909  $282,430  $310.70  772  $258,090  $334.31  ($23.61) 
Hematinics and blood cell 
stimulators  48,779  $3,558,974  $72.96  29,461  $2,954,834  $100.30  ($27.34) 
Antivirals  33,816  $22,044,737  $651.90  20,501  $15,625,395  $762.18  ($110.27) 
Streptomycins  1,070  $465,778  $435.31  440  $248,213  $564.12  ($128.82) 
Hemostatics  32  $9,886  $308.96  10  $6,982  $698.28  ($389.32) 
Corticotropins  9  $9,241  $1,026.87  4  $14,115  $3,528.87  ($2,502.00) 
Biologicals  402  $479,763  $1,193.44  221  $867,902  $3,927.16  ($2,733.72) 
Source: OIG analysis of Louisiana Medicaid data, October 1, 2005March 31, 2006. 
Top 30 National Drug Codes by Paid Amount for Affected Individual Prescription Drugs 
Tables 14a and 14b on the following pages summarize the total and average payment by 
the top 30 paid National Drug Codes (NDC) for affected individuals.  These tables differ 
by the unit of analysis. Table 14a lists the total average payments per beneficiary by 
NDC.  Since beneficiaries may have more than one prescription, they may be counted 
under more than one NDC.  Table 14b displays the total payment and average payment 
per prescription by NDC.  The top 30 NDCs were responsible for nearly a quarter of the 
total payments for affected individuals in these two quarters.   
In Table 14a, there were six NDCs for which the average payment per affected individual 
was greater than that per nonaffected individual.  Four of the six were greater by more 
than $100. These four NDCs were Oxycontin and three different dosages of Synagis.  
Oxycontin is a pain-relief medication and Synagis is used to prevent respiratory infection 
in children under 2 years of age.  Page 43  Herb Kuhn 
There are 17 NDCs in Table 14b in which the average payment per prescription for 
affected individuals was greater than that for nonaffected individuals.  Three of the NDCs 
had average payments greater than $20 and two were greater than $100.  The NDCs with 
average payments greater than $100 were two dosages of Synagis. 
Table 14a:  Prescription DrugsTotal and Average Payments per Beneficiary by Top 30 Paid NDCs for Affected 
Individuals 
Average 
Payment  Average 
 Number  Total Payments  per   Number of  Total Payments  Payment per  Difference in 
Brand  of Affected  for Affected  Affected  Nonaffected  for Nonaffected  Nonaffected  Average 
NDC  Name  Individuals   Individuals  Individual  Individuals   Individuals  Individual  Payments 
59011010710  Oxycontin  349  $1,378,370  $3,949.49  63  $208,613  $3,311.31  $638.17 
60574411401  Synagis  1,189  $2,752,973  $2,315.37  900  $1,513,415  $1,681.57  $633.80 
60574411201  Synagis  802  $1,250,183  $1,558.83  571  $655,473  $1,147.94  $410.89 
60574411101  Synagis  1,092  $3,639,285  $3,332.68  974  $3,092,151  $3,174.69  $157.99 
00310027210  Seroquel  2,001  $1,935,518  $967.28  909  $858,907  $944.89  $22.38 
00310027460  Seroquel  1,341  $1,444,103  $1,076.89  651  $693,125  $1,064.71  $12.18 
00074615160  Omnicef  11,698  $1,242,926  $106.25  4,326  $463,165  $107.07  ($0.81) 
17314585102  Concerta  3,844  $1,186,740  $308.73  1,750  $542,888  $310.22  ($1.50) 
00173045301  Flonase  20,798  $2,211,225  $106.32  10,369  $1,164,550  $112.31  ($5.99) 
00456201001  Lexapro  7,987  $1,343,974  $168.27  3,769  $658,856  $174.81  ($6.54) 
00006071131  Singulair  5,853  $1,102,521  $188.37  3,123  $611,472  $195.80  ($7.43) 
63653117106  Plavix  3,119  $1,030,204  $330.30  1,294  $441,005  $340.81  ($10.51) 
63402051224  Xopenex  12,253  $2,317,232  $189.12  5,054  $1,011,887  $200.22  ($11.10) 
00085126401  Clarinex  7,772  $1,063,313  $136.81  3,937  $585,145  $148.63  ($11.81) 
63653117101  Plavix  3,328  $1,158,567  $348.13  2,972  $1,074,462  $361.53  ($13.40) 
54092038701  Adderall Xr  4,542  $1,451,733  $319.62  1,595  $532,327  $333.75  ($14.12) 
00006027531  Singulair  6,765  $1,298,116  $191.89  3,378  $700,793  $207.46  ($15.57) 
Depakote 
00074712613  Er  2,627  $1,156,717  $440.32  1,148  $523,813  $456.28  ($15.96) 
00006011731  Singulair  6,671  $1,310,515  $196.45  3,258  $695,908  $213.60  ($17.15) 
00300304619  Prevacid  3,240  $1,188,632  $366.86  2,585  $993,023  $384.15  ($17.29) 
00024542131  Ambien  5,203  $1,084,124  $208.37  2,343  $532,300  $227.19  ($18.82) 
Advair 
00173069500  Diskus  5,695  $1,217,404  $213.77  3,222  $756,086  $234.66  ($20.90) 
50458032006  Risperdal  1,536  $1,075,143  $699.96  650  $470,094  $723.22  ($23.26) 
00186198904  Pulmicort  5,653  $1,595,411  $282.22  1,611  $492,305  $305.59  ($23.37)  Page 44  Herb Kuhn 
Table 14a:  Prescription DrugsTotal and Average Payments per Beneficiary by Top 30 Paid NDCs for Affected 
Individuals - continued 
Average 
Payment  Average 
 Number  Total Payments  per   Number of  Total Payments  Payment per  Difference in 
Brand  of Affected  for Affected  Affected  Nonaffected  for Nonaffected  Nonaffected  Average 
NDC  Name  Individuals   Individuals  Individual  Individuals   Individuals  Individual  Payments 
00186504031  Nexium  4,426  $1,547,884  $349.73  1,946  $739,901  $380.22  ($30.49) 
00300304613  Prevacid  17,980  $6,340,772  $352.66  11,386  $4,369,935  $383.80  ($31.14) 
Advair 
00173069600  Diskus  6,088  $1,779,079  $292.23  2,551  $836,157  $327.78  ($35.55) 
00186198804  Pulmicort  7,389  $1,925,185  $260.55  2,517  $746,958  $296.77  ($36.22) 
00000000000  Missing  12,863  $2,685,129  $208.75  8,480  $2,164,421  $255.24  ($46.49) 
60574411301  Synagis  1,533  $6,983,645  $4,555.54  1,337  $7,362,101  $5,506.43  ($950.89) 
All other NDCs  2,143,670  $204,517,773  $95.41  1,194,571  $118,014,147   $98.79  ($3.39) 
Total  2,319,307  $262,214,395  $113.06  1,283,240  $153,505,380   $119.62  ($6.56) 
Source: OIG analysis of Louisiana Medicaid data, October 1, 2005March 31, 2006. 
Table 14b:  Prescription DrugsTotal and Average Payments by Affected Individual Top 30 NDCs by Prescription 
Total Payments  Average  Total  Average 
Affected  for  Payment  Nonaffected  Payments for  Payment  Difference in 
Brand  Individual   Affected  per  Individual  Nonaffected  per  Average 
NDC  Name  Prescriptions  Individuals  Prescription  Prescriptions  Individuals  Prescription  Payments 
60574411401  Synagis  2,571  $2,752,973  $1,070.78  2,058  $1,513,415  $735.38  $335.40 
60574411201  Synagis  1,341  $1,250,183  $932.28  920  $655,473  $712.47  $219.81 
60574411101  Synagis  2,123  $3,639,285  $1,714.22  1,836  $3,092,151  $1,684.18  $30.04 
00310027460  Seroquel  3,759  $1,444,103  $384.17  1,902  $693,125  $364.42  $19.75 
00310027210  Seroquel  5,595  $1,935,518  $345.94  2,633  $858,907  $326.21  $19.73 
00186198904  Pulmicort  8,257  $1,595,411  $193.22  2,803  $492,305  $175.63  $17.58 
60574411301  Synagis  4,097  $6,983,645  $1,704.58  4,350  $7,362,101  $1,692.44  $12.14 
63402051224  Xopenex  18,033  $2,317,232  $128.50  8,117  $1,011,887  $124.66  $3.84 
00000000000  Missing  56,620  $2,685,129  $47.42  49,237  $2,164,421  $43.96  $3.46 
54092038701  Adderall Xr  11,809  $1,451,733  $122.93  4,437  $532,327  $119.97  $2.96 
00006071131  Singulair  11,188  $1,102,521  $98.54  6,293  $611,472  $97.17  $1.38 
00024542131  Ambien  12,175  $1,084,124  $89.05  6,069  $532,300  $87.71  $1.34 
00456201001  Lexapro  18,277  $1,343,974  $73.53  9,104  $658,856  $72.37  $1.16  Page 45  Herb Kuhn 
Table 14b:  Prescription DrugsTotal and Average Payments by Affected Individual Top 30 NDCs by Prescription - 
continued 
Total Payments  Average  Total  Average 
Affected  for  Payment  Nonaffected  Payments for  Payment  Difference in 
Brand  Individual   Affected  per  Individual  Nonaffected  per  Average 
NDC  Name  Prescriptions  Individuals  Prescription  Prescriptions  Individuals  Prescription  Payments 
63653117106  Plavix  8,058  $1,030,204  $127.85  3,481  $441,005  $126.69  $1.16 
00300304619  Prevacid  8,133  $1,188,632  $146.15  6,845  $993,023  $145.07  $1.08 
00006027531  Singulair  13,102  $1,298,116  $99.08  7,128  $700,793  $98.32  $0.76 
17314585102  Concerta  10,179  $1,186,740  $116.59  4,670  $542,888  $116.25  $0.34 
00085126401  Clarinex  14,064  $1,063,313  $75.61  7,728  $585,145  $75.72  ($0.11) 
Advair 
00173069500  Diskus  9,675  $1,217,404  $125.83  6,003  $756,086  $125.95  ($0.12) 
00173045301  Flonase  29,670  $2,211,225  $74.53  15,589  $1,164,550  $74.70  ($0.18) 
63653117101  Plavix  9,208  $1,158,567  $125.82  8,523  $1,074,462  $126.07  ($0.24) 
00074615160  Omnicef  13,564  $1,242,926  $91.63  5,038  $463,165  $91.93  ($0.30) 
Depakote 
00074712613  Er  7,699  $1,156,717  $150.24  3,473  $523,813  $150.82  ($0.58) 
Advair 
00173069600  Diskus  11,254  $1,779,079  $158.08  5,263  $836,157  $158.87  ($0.79) 
50458032006  Risperdal  4,123  $1,075,143  $260.77  1,795  $470,094  $261.89  ($1.12) 
00186504031  Nexium  10,665  $1,547,884  $145.14  5,030  $739,901  $147.10  ($1.96) 
00006011731  Singulair  13,769  $1,310,515  $95.18  7,148  $695,908  $97.36  ($2.18) 
All other 
NDCs  3,600,849  $214,162,100  $59.48  2,103,917  $123,339,652  $58.62  $0.85 
Total  3,919,857  $262,214,395  $66.89  2,291,390  $153,505,380   $66.99  ($0.10) 
Source: OIG analysis of Louisiana Medicaid data, October 1, 2005March 31, 2006. 
Top 100 Affected Individuals by Paid Amount for Prescription Drugs 
Table 15 on the following page lists the number of prescriptions and total payments for 
the top 100 affected individuals by allowed Medicaid payment.  Total prescription 
payments for the top 100 affected individuals ranged from $479,304 to $25,725, with a 
median payment of $35,900.  Fourteen of these affected individuals had payments of 
greater than $80,000 in allowed Medicaid payments during the first two quarters of FY 
2006, receiving from 8 to 94 prescriptions.  Page 46  Herb Kuhn 
Table 15:  Prescription DrugsTop 100 Affected Individuals by 
Medicaid Paid Amount 
 Number of Affected Individual  Total Payments for Affected 
Rank  Prescriptions  Individuals 
1  12  $479,304 
2  52  $287,701 
3  12  $286,659 
4  43  $236,258 
5  23  $195,944 
6  87  $182,553 
7  78  $168,740 
8  8  $124,627 
9  94  $97,702 
10  14  $95,210 
11  31  $92,701 
12  10  $90,486 
13  52  $80,723 
14  45  $80,103 
15  13  $71,333 
16  52  $67,694 
17  17  $66,621 
18  110  $62,573 
19  138  $61,510 
20  58  $60,577 
21  10  $60,303 
22  96  $59,462 
23  85  $59,093 
24  142  $58,777 
25  8  $56,961 
26  173  $55,681 
27  3  $51,923 
28  93  $51,703 
29  2  $51,058 
30  3  $49,958 
31  10  $49,128 
32  9  $48,824 
33  56  $48,553 
34  22  $45,589 
35  35  $43,467 
36  42  $42,930 
37  14  $42,453 
38  14  $42,048 
39  31  $41,627 
40  41  $41,133 
41  66  $40,564 
42  14  $39,993  Page 47  Herb Kuhn 
Table 15:  Prescription DrugsTop 100 Affected Individuals by 
Medicaid Paid Amount - continued 
 Number of Affected Individual  Total Payments for Affected 
Rank  Prescriptions  Individuals 
43  90  $37,926 
44  37  $37,015 
45  118  $36,942 
46  59  $36,942 
47  38  $36,921 
48  18  $36,892 
49  39  $36,880 
50  124  $36,021 
51  23  $35,780 
52  106  $35,774 
53  10  $35,741 
54  37  $35,598 
55  22  $34,357 
56  52  $33,531 
57  25  $33,291 
58  38  $33,184 
59  40  $32,403 
60  25  $32,056 
61  108  $31,821 
62  86  $31,301 
63  32  $30,431 
64  5  $30,030 
65  10  $29,937 
66  35  $29,913 
67  28  $29,872 
68  81  $29,778 
69  10  $29,697 
70  398  $29,354 
71  43  $29,205 
72  74  $29,000 
73  143  $28,300 
74  144  $28,136 
75  84  $28,130 
76  34  $27,981 
77  132  $27,684 
78  41  $27,578 
79  69  $27,482 
80  14  $27,441 
81  31  $27,376  Page 48  Herb Kuhn 
Table 15:  Prescription DrugsTop 100 Affected Individuals by 
Medicaid Paid Amount - continued 
 Number of Affected Individual  Total Payments for Affected 
Rank  Prescriptions  Individuals 
82  24  $27,321 
83  69  $27,099 
84  52  $27,048 
85  70  $26,964 
86  32  $26,958 
87  40  $26,935 
88  22  $26,893 
89  74  $26,868 
90  63  $26,745 
91  49  $26,740 
92  101  $26,682 
93  106  $26,514 
94  13  $26,357 
95  38  $26,352 
96  39  $26,042 
97  156  $25,946 
98  41  $25,863 
99  58  $25,850 
100  72  $25,725 
Source: OIG analysis of Louisiana Medicaid data, October 1, 2005March 31, 2006. 
Top 100 Providers by Medicaid Paid Amount for Prescription Drugs 
Table 16 on the following page lists the top 100 prescription drug providers by affected 
individual Medicaid paid amount.  For these 100 providers, the total affected individual 
paid amount ranged from $626,789 to $3,198,903, with a median of $909,112.  Forty-
eight had average payments per prescription greater for affected individuals than 
nonaffected individuals. In five cases, the average allowed amount per prescription for 
affected individuals was more than $100 higher than the average allowed amount per 
prescription for nonaffected individuals.  Of those five providers, one provided services 
only to affected individuals, and the other four provided services predominately to 
affected individuals.  Page 49  Herb Kuhn 
Table 16:  Prescription DrugsTop 100 Providers by Total Affected Individual Payments 
Average  Average 
Number of  Total  Payment  Number of  Total  Payment per 
Provider  Affected  Payments for  per Affected  Nonaffected  Payments for  Nonaffected  Difference 
Identification  Individual  Affected  Individual  Individual  Nonaffected  Individual  in Average 
Number  Prescriptions   Individual  Prescription  Prescriptions  Individual  Prescription  Payments 
0026313  771  $839,748  $1,089.17  247  $60,505  $244.96  $844.21 
0027071  339  $659,216  $1,944.59  100  $144,579  $1,445.79  $498.80 
0026341  2,668  $2,925,051  $1,096.35  86  $75,308  $875.67  $220.67 
0026040  6,629  $1,296,385  $195.56  80  $5,158  $64.48  $131.08 
0025673  5,906  $657,616  $111.35  0  $0  $0.00  $111.35 
0024918  1,053  $833,038  $791.11  1,558  $1,120,092  $718.93  $72.18 
0026317  553  $1,406,269  $2,542.98  233  $579,061  $2,485.24  $57.74 
0026869  25,379  $2,129,859  $83.92  799  $40,090  $50.17  $33.75 
0029156  645  $915,377  $1,419.19  1,051  $1,456,648  $1,385.96  $33.23 
0026392  16,387  $949,128  $57.92  174  $5,421  $31.16  $26.76 
0027093  10,346  $689,828  $66.68  295  $12,692  $43.02  $23.65 
0025311  10,428  $670,135  $64.26  52  $2,187  $42.05  $22.21 
0027186  9,035  $733,268  $81.16  344  $20,939  $60.87  $20.29 
0024085  12,362  $745,345  $60.29  158  $6,449  $40.82  $19.48 
0023446  20,842  $1,441,846  $69.18  750  $38,097  $50.80  $18.38 
0027409  11,945  $902,847  $75.58  186  $10,934  $58.78  $16.80 
0026709  10,922  $626,789  $57.39  143  $6,138  $42.92  $14.47 
0026849  8,968  $846,044  $94.34  432  $34,626  $80.15  $14.19 
0026234  9,318  $698,689  $74.98  293  $17,829  $60.85  $14.13 
0024163  14,454  $885,072  $61.23  154  $7,334  $47.63  $13.61 
0026137  22,749  $1,430,399  $62.88  510  $25,858  $50.70  $12.17 
0026988  14,089  $808,459  $57.38  238  $10,791  $45.34  $12.04 
0026462  23,641  $1,367,443  $57.84  322  $14,833  $46.07  $11.78 
0025866  9,528  $655,952  $68.84  587  $34,154  $58.18  $10.66 
0026891  12,081  $754,851  $62.48  128  $6,704  $52.37  $10.11  Page 50  Herb Kuhn 
Table 16:  Prescription DrugsTop 100 Providers by Total Affected Individual Payments - continued 
Average  Average 
Number of  Total  Payment  Number of  Total  Payment per 
Provider  Affected  Payments for  per Affected  Nonaffected  Payments for  Nonaffected  Difference 
Identification  Individual  Affected  Individual  Individual  Nonaffected  Individual  in Average 
Number  Prescriptions   Individual  Prescription  Prescriptions  Individual  Prescription  Payments 
0021691  17,259  $894,705  $51.84  389  $16,716  $42.97  $8.87 
0027514  29,784  $1,716,413  $57.63  277  $13,633  $49.22  $8.41 
0024066  28,884  $2,365,391  $81.89  317  $23,443  $73.95  $7.94 
0027410  15,003  $794,456  $52.95  173  $7,944  $45.92  $7.03 
0027092  38,103  $2,554,480  $67.04  894  $54,600  $61.07  $5.97 
0026598  15,505  $933,692  $60.22  410  $22,408  $54.65  $5.56 
0026179  24,532  $1,371,962  $55.93  245  $12,402  $50.62  $5.30 
0026181  11,294  $638,775  $56.56  126  $6,515  $51.70  $4.85 
0026371  16,169  $873,137  $54.00  160  $8,009  $50.05  $3.95 
0026594  15,441  $883,392  $57.21  223  $11,966  $53.66  $3.55 
0027211  18,459  $1,084,255  $58.74  201  $11,137  $55.41  $3.33 
0021845  10,796  $747,833  $69.27  264  $17,435  $66.04  $3.23 
0026580  9,761  $631,037  $64.65  172  $10,643  $61.88  $2.77 
0026905  14,568  $661,755  $45.43  338  $14,576  $43.13  $2.30 
0026373  12,731  $691,673  $54.33  3,020  $157,889  $52.28  $2.05 
0027106  13,433  $757,768  $56.41  350  $19,147  $54.71  $1.70 
0024197  34,783  $2,595,229  $74.61  16,409  $1,202,519  $73.28  $1.33 
0024283  23,962  $1,440,366  $60.11  452  $26,756  $59.20  $0.92 
0024133  15,473  $1,396,153  $90.23  294  $26,284  $89.40  $0.83 
0026931  10,400  $636,209  $61.17  584  $35,528  $60.84  $0.34 
0026983  21,813  $1,125,707  $51.61  392  $20,134  $51.36  $0.24 
0026147  28,328  $1,636,426  $57.77  323  $18,607  $57.61  $0.16 
0026795  12,570  $714,696  $56.86  143  $8,128  $56.84  $0.02 
0026259  14,150  $917,403  $64.83  347  $22,511  $64.87  ($0.04) 
0027436  20,155  $1,333,864  $66.18  6,739  $450,285  $66.82  ($0.64) 
0021521  12,690  $762,879  $60.12  276  $16,832  $60.98  ($0.87) 
0026133  13,065  $746,403  $57.13  186  $10,890  $58.55  ($1.42)  Page 51  Herb Kuhn 
Table 16:  Prescription DrugsTop 100 Providers by Total Affected Individual Payments - continued 
Average  Average 
Number of  Total  Payment  Number of  Total  Payment per 
Provider  Affected  Payments for  per Affected  Nonaffected  Payments for  Nonaffected  Difference 
Identification  Individual  Affected  Individual  Individual  Nonaffected  Individual  in Average 
Number  Prescriptions   Individual  Prescription  Prescriptions  Individual  Prescription  Payments 
0026413  10,370  $747,082  $72.04  120  $8,820  $73.50  ($1.46) 
0021636  12,151  $694,277  $57.14  167  $9,900  $59.28  ($2.15) 
0025519  12,566  $638,717  $50.83  819  $43,541  $53.16  ($2.33) 
0020766  16,340  $1,118,018  $68.42  683  $48,347  $70.79  ($2.36) 
0024268  15,558  $925,793  $59.51  320  $19,810  $61.91  ($2.40) 
0025958  12,936  $736,013  $56.90  133  $7,910  $59.48  ($2.58) 
0026850  22,279  $1,447,520  $64.97  31,034  $2,111,510  $68.04  ($3.07) 
0026583  46,015  $2,660,232  $57.81  232  $14,501  $62.50  ($4.69) 
0026772  27,029  $1,787,771  $66.14  39,451  $2,808,013  $71.18  ($5.03) 
0027169  21,633  $1,259,250  $58.21  528  $33,425  $63.31  ($5.10) 
0025191  28,343  $1,672,841  $59.02  344  $22,608  $65.72  ($6.70) 
0027404  17,862  $951,781  $53.29  258  $15,593  $60.44  ($7.15) 
0026149  12,726  $738,570  $58.04  152  $10,052  $66.13  ($8.10) 
0025557  10,342  $650,765  $62.92  128  $9,171  $71.65  ($8.72) 
0022605  15,504  $806,279  $52.00  530  $32,204  $60.76  ($8.76) 
0027481  11,291  $1,203,508  $106.59  217  $25,054  $115.46  ($8.87) 
0026920  11,767  $1,000,120  $84.99  1,505  $141,743  $94.18  ($9.19) 
0025365  23,436  $1,570,457  $67.01  292  $22,508  $77.08  ($10.07) 
0027133  12,077  $629,417  $52.12  821  $51,731  $63.01  ($10.89) 
0023378  12,191  $712,230  $58.42  175  $12,234  $69.91  ($11.49) 
0025366  25,123  $1,187,808  $47.28  454  $26,711  $58.83  ($11.55) 
0026617  13,430  $775,291  $57.73  132  $9,536  $72.24  ($14.52) 
0026331  12,726  $779,437  $61.25  171  $12,982  $75.92  ($14.67) 
0027115  6,046  $1,119,596  $185.18  6,265  $1,265,851  $202.05  ($16.87) 
0025477  9,280  $672,870  $72.51  114  $10,306  $90.41  ($17.90) 
0026893  13,636  $813,591  $59.66  121  $9,423  $77.88  ($18.21) 
0022871  21,502  $1,345,444  $62.57  621  $52,486  $84.52  ($21.95)  Page 52  Herb Kuhn 
Table 16:  Prescription Drugs - Top 100 Providers by Total Affected Individual Payments - continued 
Average  Average 
Number of  Total  Payment  Number of  Total  Payment per 
Provider  Affected  Payments for  per Affected  Nonaffected  Payments for  Nonaffected  Difference 
Identification  Individual  Affected  Individual  Individual  Nonaffected  Individual  in Average 
Number  Prescriptions   Individual  Prescription  Prescriptions  Individual  Prescription  Payments 
0026875  17,862  $887,324  $49.68  216  $15,498  $71.75  ($22.07) 
0026180  11,803  $740,029  $62.70  159  $13,785  $86.70  ($24.00) 
0026069  19,405  $944,298  $48.66  226  $16,483  $72.93  ($24.27) 
0027078  17,274  $1,276,017  $73.87  270  $27,273  $101.01  ($27.14) 
0026166  10,442  $1,030,003  $98.64  1,104  $142,595  $129.16  ($30.52) 
0025161  19,439  $1,143,866  $58.84  361  $32,374  $89.68  ($30.83) 
0027141  10,556  $2,627,860  $248.94  379  $108,025  $285.03  ($36.08) 
0026819  10,449  $1,002,881  $95.98  382  $51,136  $133.86  ($37.89) 
0023351  23,071  $1,242,897  $53.87  886  $83,000  $93.68  ($39.81) 
0024291  14,063  $823,015  $58.52  243  $25,431  $104.65  ($46.13) 
0026364  5,947  $719,704  $121.02  279  $47,231  $169.29  ($48.27) 
0026754  14,492  $859,054  $59.28  235  $29,063  $123.67  ($64.39) 
0021761  37,323  $2,912,026  $78.02  3,370  $482,999  $143.32  ($65.30) 
0027492  16,433  $917,738  $55.85  172  $21,878  $127.20  ($71.35) 
0026811  2,561  $640,020  $249.91  1,318  $443,604  $336.57  ($86.66) 
0026738  4,267  $3,198,903  $749.68  1,734  $1,624,045  $936.59  ($186.90) 
0027522  10,194  $658,018  $64.55  13,087  $3,561,396  $272.13  ($207.58) 
0026828  2,668  $1,152,472  $431.96  1,586  $1,282,476  $808.62  ($376.66) 
0026093  13,822  $2,832,370  $204.92  275  $164,131  $596.84  ($391.92) 
0026669  1,209  $1,089,770  $901.38  45  $61,170  $1,359.34  ($457.96) 
0027155  328  $1,207,636  $3,681.82  98  $1,069,591  $10,914.20  ($7,232.38) 
Source: OIG analysis of Louisiana Medicaid data, October 1, 2005March 31, 2006.  Page 53  Herb Kuhn 
If you have any questions about this memorandum report, please do not hesitate to 
contact me, or one of your staff may contact Claire Barnard, Director, External Affairs, at 
(202) 619-1665 or through e-mail [Claire.Barnard@oig.hhs.gov].  To facilitate 
identification, please refer to memorandum report number OEI-05-07-00300 in all 
correspondence.