PM 20-05-00: Recipient Restriction Program (AABD, TANF)

WAG 20-05-00.

The Bureau of Medical Quality Assurance runs the Recipient Restriction Program (RRP). The program's goal is to reduce excess use and abuse of the medical program by restricting the client to one physician, pharmacy, or HMO.

The Bureau reviews cases that have above normal use of services and cases that have been reported by an outside source, such as a physician. AABD(A) and AABD(B) clients and clients living in institutions may be reviewed, but are not restricted.

Other client actions that may cause a review are:

• loaning or altering MediPlan cards to receive benefits a person is not entitled to;
• falsely representing medical coverage;
• having forged prescriptions or blank prescription pads; and
• knowingly helping providers defraud HFS.