DEPARTMENT OF HEALTH &. HUMAN SERVICES 

TO: 

FROM: 

JUL 2 5 2007 

Herb Kuhn 

Acting Deputy Administrator 

Centers for Medicare & Medicaid Services 

Daniel R. Levinson 

Inspector General 

Office of Inspector General 

Washington, D.C. 20201 

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, I to ensure the delivery of health care services to evacuees and 

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 York’s 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 Children’s 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 

Louisiana’s 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, 2005–March 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 longterm 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 Services—Payments by Beneficiaries’ Individual Status 

Individual Status 

Unique Beneficiary 

Count Total Payment 

Average 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, 2005–March 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 Services—Total and Average Payment per Beneficiary by Month 

Month 

Affected 

Individuals 

Receiving 

Services 

Total 

Payments for 

Affected 

Individuals 

Average 

Payment per 

Affected 

Individual

 Nonaffected 

Individuals 

Receiving 

Services 

Total Payments 

for Nonaffected 

Individuals 

Average 

Payment per 

Nonaffected 

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, 2005–March 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 parishes—Orleans, Jefferson, and East Baton Rouge—accounted 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 Services—Total and Average Payment by Parish 

Parish 

Affected 

Individuals 

Receiving 

Services 

Percentage 

of Total 

Affected 

Individuals 

Total 

Payments 

for Affected 

Individuals 

Average 

Payment 

per 

Affected 

Individual 

Nonaffected 

Individuals 

Receiving 

Services 

Percentage 

of Total 

Nonaffected 

Individuals 

Total 

Payments 

for 

Nonaffected 

Individuals 

Average 

Payment 

per 

Nonaffected 

Individuals 

Difference 

in Average 

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 Services—Total and Average Payment by Parish - continued 

Parish 

Affected 

Individuals 

Receiving 

Services 

Percentage 

of Total 

Affected 

Individuals 

Total 

Payments 

for Affected 

Individuals 

Average 

Payment 

per 

Affected 

Individual 

Nonaffected 

Individuals 

Receiving 

Services 

Percentage 

of Total 

Nonaffected 

Individuals 

Total 

Payments 

for 

Nonaffected 

Individuals 

Average 

Payment per 

Nonaffected 

Individual 

Difference 

in Average 

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, 2005–March 31, 2006. 
Page 9 – Herb Kuhn 

Figure 2: Medical Services—Average Payment by Parish for 

Nonaffected Individuals 

Figure 1: Medical Services—Average Payment by Parish for 

Affected Individuals 
Page 10 – Herb Kuhn 

Figure 3: Medical Services—Affected Individual Distribution by 

Parish 

Figure 4: Medical Services—Nonaffected 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 Services—Total and Average Payments per Beneficiary by Eligibility Category 

Eligibility Category and 

Description 

Affected 

Individuals 

Receiving 

Services 

Total 

Payments 

for Affected 

Individuals 

Average 

Payment 

per 

Affected 

Individual 

Nonaffected 

Individuals 

Receiving 

Services 

Total 

Payments for 

Nonaffected 

Individuals 

Average 

Payment per 

Nonaffected 

Individual 

Difference 

in Average 

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 Services—Total and Average Payments per Beneficiary by Eligibility Category - continued 

Eligibility Category and 

Description 

Affected 

Individuals 

Receiving 

Services 

Total 

Payments 

for Affected 

Individuals 

Average 

Payment 

per 

Affected 

Individual 

Nonaffected 

Individuals 

Receiving 

Services 

Total Payments 

for Nonaffected 

Individuals 

Average 

Payment 

per 

Nonaffected 

Individual 

Difference in 

Average 

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, 2005–March 31, 2006. 

Table 4b: Medical Services—Total and Average Payments per Service by Eligible Category 

Eligibility Category and 

Description 

Number of 

Affected 

Individual 

Services 

Total 

Payments for 

Affected 

Individuals 

Average 

Payment Per 

Affected 

Individual 

Service 

Number of 

Nonaffected 

Individual 

Services 

Total 

Payments for 

Nonaffected 

Individuals 

Average 

Payment Per 

Nonaffected 

Individual 

Service 

Difference 

in Average 

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, 2005–March 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 Services—Total and Average Payments per Beneficiary by Service Type 

Service Type 

Affected 

Individuals 

Receiving 

Services 

Total Payments 

for Affected 

Individuals 

Average 

Payment 

per 

Affected 

Individual 

Nonaffected 

Individuals 

Receiving 

Services 

Total 

Payments 

for 

Nonaffected 

Individuals 

Average 

Payment 

per 

Nonaffected 

Individual 

Difference 

in Average 

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 1

Other includes durable medical equipment, emergency ambulance services, prenatal care clinic services, EPSDT case 

management, ventilator-assisted children’s 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 Services—Total and Average Payments per Beneficiary by Service Type - continued 

Service Type 

Affected 

Individuals 

Receiving 

Services 

Total Payments 

for Affected 

Individuals 

Average 

Payment 

per 

Affected 

Individual 

Nonaffected 

Individuals 

Receiving 

Services 

Total 

Payments 

for 

Nonaffected 

Individuals 

Average 

Payment 

per 

Nonaffected 

Individual 

Difference 

in Average 

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, 2005–March 31, 2006. 
Page 15 – Herb Kuhn 

Table 5b: Medical Services—Total and Average Payments per Service by Service Type 

Type of Service 

Number 

of 

Affected 

Individual 

Services 

Total 

Payments 

for Affected 

Individuals 

Average 

Payment 

per 

Affected 

Individual 

Service 

Number of 

Nonaffected 

Individual 

Services 

Total 

Payments for 

Nonaffected 

Individuals 

Average 

Payment 

Per 

Nonaffected 

Individual 

Service 

Difference 

in Average 

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) 1

Other 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 Services—Total and Average Payments per Service by Service Type - continued 

Type of Service 

Number of 

Affected 

Individual 

Services 

Total 

Payments 

for Affected 

Individuals 

Average 

Payment 

per 

Affected 

Individual 

Service 

Number of 

Nonaffected 

Individual 

Services 

Total 

Payments for 

Nonaffected 

Individuals 

Average 

Payment 

Per 

Nonaffected 

Individual 

Service 

Difference in 

Average 

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, 2005–March 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 Services—Total and Average Payments per Affected Individual by Top 30 Paid Procedures 

for Affected Individuals 

Procedure Code and Short 

Description 

Affected 

Individuals 

Receiving 

Services 

Total 

Payments 

for Affected 

Individuals 

Average 

Payment 

per 

Affected 

Individual 

Nonaffected 

Individuals 

Receiving 

Services 

Total 

Payments 

for 

Nonaffected 

Individuals 

Average 

Payment per 

Nonaffected 

Individual 

Difference 

in Average 

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 Services—Total and Average Payments per Affected Individual by Top 30 Paid 

Procedures for Affected Individuals - continued 

Procedure Code and Short 

Description 

Affected 

Individuals 

Receiving 

Services 

Total 

Payments 

for Affected 

Individuals 

Average 

Payment 

per 

Affected 

Individual 

Nonaffected 

Individuals 

Receiving 

Services 

Total 

Payments 

for 

Nonaffected 

Individuals 

Average 

Payment 

per 

Nonaffected 

Individual 

Difference 

in Average 

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, 2005–March 31, 2006. 

Table 6b: Medical Services—Total and Average Payments per Service by Top 30 Paid Procedures for 

Affected Individuals 

Procedure Code and Short 

Description 

 Affected 

Individual 

Services 

Total 

Payments for 

Affected 

Individuals 

Average 

Payment 

per 

Affected 

Individual 

Nonaffected 

Individual 

Services 

Total 

Payments for 

Nonaffected 

Individuals 

Average 

Payment 

per 

Nonaffected 

Individual 

Difference 

in Average 

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 Services—Total and Average Payments per Service by Top 30 Paid Procedures for Affected 

Individuals - continued 

Procedure Code and Short 

Description 

 Affected 

Individual 

Services 

Total Payments 

for 

Affected 

Individuals 

Average 

Payment 

per Affected 

Individual

 Nonaffected 

Individual 

Services 

Total Payments 

for 

Nonaffected 

Individuals 

Average 

Payment 

per 

Nonaffected 

Individual 

Difference 

in Average 

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, 2005–March 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 Services—Top 100 Affected Individuals by Total 

Payments for Medical Services 

Rank Among Affected 

Individuals Number of Services 

Total Payments for Affected 

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 Services—Top 100 Affected Individuals by Total 

Payments for Medical Services - continued 

Rank Among Affected 

Individuals Number of Services 

Total Payments for Affected 

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 Services—Top 100 Affected Individuals by Total 

Payments for Medical Services - continued 

Rank Among Affected 

Individuals Number of Services 

Total Payments for Affected 

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, 2005–March 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 Services—Top 100 Service Providers by Total Affected Individual Payments 

Provider 

Number 

Number of 

Affected 

Individual 

Services 

Total 

Payments for 

Affected 

Individuals 

Average 

Payment per 

Affected 

Individual 

Service 

Number of 

Nonaffected 

Individuals 

Services 

Total 

Payments for 

Nonaffected 

Individuals 

Average 

Payment per 

Nonaffected 

Individual 

Service 

Difference 

in Average 

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 Services—Top 100 Service Providers by Total Affected Individual Payments - 

continued 

Provider 

Number 

Number of 

Affected 

Individual 

Services 

Total 

Payments for 

 Affected 

Individuals 

Average 

Payment Per 

Affected 

Individual 

Service 

Number of 

Nonaffected 

Individuals 

Services 

Total 

Payments for 

Nonaffected 

Individuals 

Average 

Payment Per 

Nonaffected 

Individual 

Service 

Difference 

 in Average 

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 Services—Top 100 Service Providers by Total Affected Individual Payments - 

continued 

Provider 

Number 

Number 

of 

Affected 

Individual 

Services 

Total 

Payments for 

 Affected 

Individuals 

Average 

Payment Per 

Affected 

Individual 

Service 

Number of 

Nonaffected 

Individuals 

Services 

Total 

Payments 

for 

Nonaffected 

Individuals 

Average 

Payment 

Per 

Nonaffected 

Individual 

Service 

Difference 

in Average 

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, 2005–March 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 Drugs—Payments 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, 2005–March 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 Drugs—Total and Average Payment per Beneficiary by Month 

Month 

Affected 

Individuals 

Receiving 

Prescriptions 

Total Payments 

for Affected 

Individuals 

Average 

Payment 

per Affected 

Individual 

Nonaffected 

Individuals 

Receiving 

Prescriptions 

Total Payments for 

Nonaffected 

Individuals 

Average 

Payment per 

Nonaffected 

Individual 

October 2005 

November 2005 

December 2005 

January 2006 

February 2006 

March 2006 

205,555 

206,499 

208,266 

186,002 

180,301 

190,508 

$51,698,771 

$50,569,081 

$52,997,918 

$35,525,508 

$33,299,951 

$38,123,163 

$251.51 

$244.89 

$254.47 

$191.00 

$184.69 

$200.11 

 111,970 

 112,400 

 113,320 

95,320 

94,960 

99,725 

$30,931,593 

$30,970,966 

$32,361,163 

$19,610,162 

$18,650,108 

$20,981,385 

$276.25 

$275.54 

$285.57 

$205.73 

$196.40 

$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, 2005–March 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 

parishes—East Baton Rouge, Jefferson, and Orleans—accounted 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 Drugs—Total and Average Payment by Parish 

Parish 

Affected 

Individuals 

Receiving 

Prescriptions 

Percentage 

of Total 

Affected 

Individuals 

Total 

Payments 

for Affected 

Individuals 

Average 

Payment 

per 

Affected 

Individual 

Nonaffected 

Individuals 

Receiving 

Prescriptions 

Percentage 

of Total 

Nonaffected 

Individuals 

Total 

Payments 

for 

Nonaffected 

Individuals 

Average 

Payment 

per 

Nonaffected 

Individual 

Difference 

in 

Average 

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 Drugs—Total and Average Payment by Parish - continued 

Parish 

Affected 

Individuals 

Receiving 

Prescriptions 

Percentage 

of Total 

Affected 

Individuals 

Total 

Payments 

for Affected 

Individuals 

Average 

Payment 

per 

Affected 

Individual 

Nonaffected 

Individuals 

Receiving 

Prescriptions 

Percentage 

of Total 

Nonaffected 

Individuals 

Total 

Payments 

for 

Nonaffected 

Individuals 

Average 

Payment 

per 

Nonaffected 

Individual 

Difference 

in 

Average 

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 

Parish 

Affected 

Individuals 

Receiving 

Prescriptions 

Percentage 

of Total 

Affected 

Individuals 

Total 

Payments 

for Affected 

Individuals 

Average 

Payment 

per 

Affected 

Individual 

Nonaffected 

Individuals 

Receiving 

Prescriptions 

Percentage 

of Total 

Nonaffected 

Individuals 

Total 

Payments 

for 

Nonaffected 

Individuals 

Average 

Payment 

per 

Nonaffected 

Individual 

Difference 

in 

Average 

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, 2005–March 31, 2006. 
Page 30 – Herb Kuhn 

Figure 5: Prescription Drugs—Average Payment by Parish for 

Affected Individuals 

Figure 6: Prescription Drugs—Average Payment by Parish for 

Nonaffected Individuals 
Page 31 – Herb Kuhn 

Figure 7: Prescription Drugs—Affected Individual Distribution 

by Parish 

Figure 8: Prescription Drugs—Nonaffected 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 Drugs—Total and Average Payments per Beneficiary by Eligibility Category 

Eligibility Category 

and Description

 Affected 

Individuals 

Receiving 

Prescriptions 

Total Payments 

for Affected 

Individuals 

Average 

Payment 

per 

Affected 

Individual 

Nonaffected 

Individuals 

Receiving 

Prescriptions 

Total 

Payments for 

Nonaffected 

Individuals 

Average 

Payment 

per 

Nonaffected 

Individual 

Difference 

in Average 

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 Drugs—Total and Average Payments per Beneficiary by Eligibility Category 

continued 

Eligibility Category and 

Description 

Affected 

Individuals 

Receiving 

Prescriptions 

Total Payments 

for Affected 

Individuals 

Average 

Payment 

per 

Affected 

Individual 

Nonaffected 

Individuals 

Receiving 

Prescriptions 

Total Payments 

for Nonaffected 

Individuals 

Average 

Payment 

per 

Nonaffected 

Individual 

Difference 

in Average 

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, 2005–March 31, 2006. 

Table 12b: Prescription Drugs—Total and Average Payments per Prescription by Eligibility Category 

Eligibility Category and 

Description 

Number of 

Affected 

Individual 

Prescriptions 

Total Payments 

for Affected 

Individuals 

Average 

Payment 

per Affected 

Individual 

Prescription 

Number of 

Nonaffected 

Individual 

Prescriptions 

Total 

Payments for 

Nonaffected 

Individuals 

Average 

Payment 

per 

Nonaffected 

Individual 

Prescription 

Difference 

in Average 

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 Drugs—Total and Average Payments per Prescription by Eligibility Category - continued 

Eligibility Category and 

Description 

Number of 

Affected 

Individual 

Prescriptions 

Total 

Payments for 

Affected 

Individuals 

Average 

Payment 

per Affected 

Individual 

Prescription 

Number of 

Nonaffected 

Individual 

Prescriptions 

Total 

Payments for 

Nonaffected 

Individuals 

Average 

Payment 

per 

Nonaffected 

Individual 

Prescription 

Difference in 

Average 

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, 2005–March 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 one—antidotes—was 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 drug’s manufacturer, name, dosage form, strength, and package size. 
Page 35 – Herb Kuhn 

Table 13a: Prescription Drugs—Total and Average Payments per Beneficiary by STC 

STC 

Affected 

Individuals 

Receiving 

Prescriptions 

Total 

Payments for 

Affected 

Individuals 

Average 

Payment 

per 

Affected 

Individual 

Nonaffected 

Individuals 

Receiving 

Prescriptions 

Total Payments 

for Nonaffected 

Individuals 

Average 

Payment 

per 

Nonaffected 

Individual 

Difference in 

Average 

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 Drugs—Total and Average Payments per Beneficiary by STC - continued 

STC 

Affected 

Individuals 

Receiving 

Prescriptions 

Total 

Payments for 

Affected 

Individuals 

Average 

Payment 

per 

Affected 

Individual 

Nonaffected 

Individuals 

Receiving 

Prescriptions 

Total Payments 

for Nonaffected 

Individuals 

Average 

Payment 

per 

Nonaffected 

Individual 

Difference 

in Average 

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 Drugs—Total and Average Payments per Beneficiary by STC - continued 

STC 

Affected 

Individuals 

Receiving 

Prescriptions 

Total 

Payments for 

Affected 

Individuals 

Average 

Payment 

per 

Affected 

Individual 

Nonaffected 

Individuals 

Receiving 

Prescriptions 

Total Payments 

for Nonaffected 

Individuals 

Average 

Payment 

per 

Nonaffected 

Individual 

Difference 

in Average 

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 Drugs—Total and Average Payments per Beneficiary by STC - continued 

STC 

Affected 

Individuals 

Receiving 

Prescriptions 

Total 

Payments for 

Affected 

Individuals 

Average 

Payment 

per 

Affected 

Individual 

Nonaffected 

Individuals 

Receiving 

Prescriptions 

Total Payments 

for Nonaffected 

Individuals 

Average 

Payment 

per 

Nonaffected 

Individual 

Difference 

in Average 

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, 2005–March 31, 2006. 
Page 39 – Herb Kuhn 

Table 13b: Prescription Drugs—Total and Average Payments per Prescription by STC 

STC 

Number of 

Affected 

Individual 

Prescriptions 

Total 

Payments for 

Affected 

Individuals 

Average 

Payment 

per Affected 

Individual 

Prescription 

Number of 

Nonaffected 

Individual 

Prescriptions 

Total 

Payments for 

Nonaffected 

Individuals 

Average 

Payment 

per 

Nonaffected 

Individual 

Prescription 

Difference 

in Average 

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 Drugs—Total and Average Payments per Prescription by STC - continued 

STC 

Number of 

Affected 

Individual 

Prescriptions 

Total 

Payments for 

Affected 

Individuals 

Average 

Payment 

per Affected 

Individual 

Prescription 

Number of 

Nonaffected 

Individual 

Prescriptions 

Total 

Payments for 

Nonaffected 

Individuals 

Average 

Payment 

per 

Nonaffected 

Individual 

Prescription 

Difference 

in Average 

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 Drugs—Total and Average Payments per Prescription by STC - continued 

STC 

Number of 

Affected 

Individual 

Prescriptions 

Total 

Payments for 

Affected 

Individuals 

Average 

Payment 

per Affected 

Individual 

Prescription 

Number of 

Nonaffected 

Individual 

Prescriptions 

Total 

Payments 

for 

Nonaffected 

Individuals 

Average 

Payment 

per 

Nonaffected 

Individual 

Prescription 

Difference 

in Average 

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 Drugs—Total and Average Payments per Prescription by STC - continued 

STC 

Number of 

Affected 

Individual 

Prescriptions 

Total 

Payments for 

Affected 

Individuals 

Average 

Payment 

per Affected 

Individual 

Prescription 

Number of 

Nonaffected 

Individual 

Prescriptions 

Total 

Payments for 

Nonaffected 

Individuals 

Average 

Payment 

per 

Nonaffected 

Individual 

Prescription 

Difference in 

Average 

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, 2005–March 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 Drugs—Total and Average Payments per Beneficiary by Top 30 Paid NDCs for Affected 

Individuals 

NDC 

Brand 

Name 

 Number 

of Affected 

Individuals 

Total Payments 

for Affected 

Individuals 

Average 

Payment 

per 

Affected 

Individual 

 Number of 

Nonaffected 

Individuals 

Total Payments 

for Nonaffected 

Individuals 

Average 

Payment per 

Nonaffected 

Individual 

Difference in 

Average 

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) 

00074712613 

Depakote 

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) 

00173069500 

Advair 

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 Drugs—Total and Average Payments per Beneficiary by Top 30 Paid NDCs for Affected 

Individuals - continued 

NDC 

Brand 

Name 

 Number 

of Affected 

Individuals 

Total Payments 

for Affected 

Individuals 

Average 

Payment 

per 

Affected 

Individual 

 Number of 

Nonaffected 

Individuals 

Total Payments 

for Nonaffected 

Individuals 

Average 

Payment per 

Nonaffected 

Individual 

Difference in 

Average 

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) 

00173069600 

Advair 

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, 2005–March 31, 2006. 

Table 14b: Prescription Drugs—Total and Average Payments by Affected Individual Top 30 NDCs by Prescription 

NDC 

Brand 

Name 

Affected 

Individual 

Prescriptions 

Total Payments 

for 

Affected 

Individuals 

Average 

Payment 

per 

Prescription 

Nonaffected 

Individual 

Prescriptions 

Total 

Payments for 

Nonaffected 

Individuals 

Average 

Payment 

per 

Prescription 

Difference in 

Average 

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 Drugs—Total and Average Payments by Affected Individual Top 30 NDCs by Prescription - 

continued 

NDC 

Brand 

Name 

Affected 

Individual 

Prescriptions 

Total Payments 

for 

Affected 

Individuals 

Average 

Payment 

per 

Prescription 

Nonaffected 

Individual 

Prescriptions 

Total 

Payments for 

Nonaffected 

Individuals 

Average 

Payment 

per 

Prescription 

Difference in 

Average 

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) 

00173069500 

Advair 

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) 

00074712613 

Depakote 

Er 7,699 $1,156,717 $150.24 3,473 $523,813 $150.82 ($0.58) 

00173069600 

Advair 

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, 2005–March 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 Drugs—Top 100 Affected Individuals by 

Medicaid Paid Amount 

Rank 

 Number of Affected Individual 

Prescriptions 

Total Payments for Affected 

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 Drugs—Top 100 Affected Individuals by 

Medicaid Paid Amount - continued 

Rank 

 Number of Affected Individual 

Prescriptions 

Total Payments for Affected 

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 Drugs—Top 100 Affected Individuals by 

Medicaid Paid Amount - continued 

Rank 

 Number of Affected Individual 

Prescriptions 

Total Payments for Affected 

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, 2005–March 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. Fortyeight 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 Drugs—Top 100 Providers by Total Affected Individual Payments 

Provider 

Identification 

Number 

Number of 

Affected 

Individual 

Prescriptions 

Total 

Payments for 

Affected 

Individual 

Average 

Payment 

per Affected 

Individual 

Prescription 

Number of 

Nonaffected 

Individual 

Prescriptions 

Total 

Payments for 

Nonaffected 

Individual 

Average 

Payment per 

Nonaffected 

Individual 

Prescription 

Difference 

in Average 

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 Drugs—Top 100 Providers by Total Affected Individual Payments - continued 

Provider 

Identification 

Number 

Number of 

Affected 

Individual 

Prescriptions 

Total 

Payments for 

Affected 

Individual 

Average 

Payment 

per Affected 

Individual 

Prescription 

Number of 

Nonaffected 

Individual 

Prescriptions 

Total 

Payments for 

Nonaffected 

Individual 

Average 

Payment per 

Nonaffected 

Individual 

Prescription 

Difference 

in Average 

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 Drugs—Top 100 Providers by Total Affected Individual Payments - continued 

Provider 

Identification 

Number 

Number of 

Affected 

Individual 

Prescriptions 

Total 

Payments for 

Affected 

Individual 

Average 

Payment 

per Affected 

Individual 

Prescription 

Number of 

Nonaffected 

Individual 

Prescriptions 

Total 

Payments for 

Nonaffected 

Individual 

Average 

Payment per 

Nonaffected 

Individual 

Prescription 

Difference 

in Average 

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 

Provider 

Identification 

Number 

Number of 

Affected 

Individual 

Prescriptions 

Total 

Payments for 

Affected 

Individual 

Average 

Payment 

per Affected 

Individual 

Prescription 

Number of 

Nonaffected 

Individual 

Prescriptions 

Total 

Payments for 

Nonaffected 

Individual 

Average 

Payment per 

Nonaffected 

Individual 

Prescription 

Difference 

in Average 

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, 2005–March 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.