Bob’s Pharmacy has several Medicaid patients. One of the physicians tends to write his Medicaid prescriptions for brand name drugs, even though generic drugs are available. When Bob calls the prescriber to seek authority to substitute, the prescriber tells him to write “medically necessary” on these prescriptions. Bob is part of a buying cooperative that continually changes the companies from which it purchases generic drugs nearly every month. Because the generic equivalents are all about the same price to Bob, he cannot see changing the National Drug Code (NDC) numbers in the computer all the time. Therefore, Bob often will dispense a generic drug but submit a claim to Medicaid with an NDC number other than the one dispensed. Several Medicaid patients do not pick up the prescriptions that are phoned in to Bob. Bob submits the claim when he fills the prescription but does not always remember to notify Medicaid when the prescription is not picked up.

a. List three potential Medicaid violations that exist in this scenario and explain why they could be violations.

b. Why might it cause the state and the manufacturers problems if Bob uses the wrong NDC number for his claims, even if his cost is the same for the drug dispensed as it is for the drug whose NDC number he used?