Two or more of the following apply in a consecutive 90-day period:

• Saw 4 or more physicians
• Filled prescriptions at 4 or more pharmacies
• Received 10 or more prescriptions
• Had prescriptions written by 4 or more prescribers
• Received similar services from 2 or more providers in the same day
• Had 10 or more office visits

Any one of the following apply in a 90-day period:

• Made 2 or more ER visits
• Medical history indicating at-risk utilization patterns
• Made repeated and documented efforts to seek medically unnecessary services
• Was counseled at least once by health care provider about appropriate use of health care services.

Received prescriptions for controlled substances from 2 or more different prescribers in any month.

Client's medical billing history demonstrates a pattern of of the following:

• History of using healthcare services in a manner that is duplicative, excessive or contraindicated.
• History of receiving conflicting healthcare services, drugs or supplies that are not within acceptable medical practice.