(1) Services not rendered. 100% of the ingredient cost and professional fee, if any, paid shall be recovered where:

(2) Noncovered services. 100% of the ingredient cost and professional fee, if any, paid shall be recovered where:

(3) Prescription Splitting. Where the pharmacist, without authorization from the prescriber, dispensed a smaller quantity than prescribed or subsequently authorized which resulted in dispensing one or more refills to provide the beneficiary with an equivalent or nearly equivalent quantity as originally prescribed or subsequently authorized, 100% of the professional fee paid for each such refill shall be recovered. The provisions of this subsection are not applicable to prescriptions reduced to the extent necessary to comply with Section 51313(b).

(4) Excessive refills. Where the refills dispensed exceed the directions for use of the original prescription, 100% of the ingredient cost and professional fee, if any, paid for each refill shall be recovered.

(5) Duplicate billings. 100% of the ingredient cost and professional fee, if any, shall be recovered where the provider bills or submits a claim to the Department for which the provider has received and retained payment from the Department, the beneficiary, or from another person on behalf of the beneficiary, subject to the exceptions found in Section 51471.

(6) Discriminatory Billing. Where the provider bills or submits a claim for services in any amount in excess of the charge for the same service to the general public, the difference between the amount paid and the charge to the general public shall be recovered, subject to the exceptions found in Section 51480(b).

(7) False and Misleading Information. 100% of the ingredient cost and professional fee, if any, paid shall be recovered where the provider submits or causes to be submitted any false or misleading statement of material fact on or in connection with any claim which results in reimbursement for ingredient costs and professional fees, if any, not allowed under the regulations of this division.

(8) Drug Discrepancy.

(9) Quantity discrepancy. Where the quantity of drug billed is larger than the quantity of drug dispensed, the difference in the allowable cost between the quantity paid and quantity dispensed shall be recovered.

(10) Strength discrepancy. Where the strength of the drug billed is greater than the strength of the drug prescribed or dispensed, the difference in the allowable cost between the strength paid and that prescribed or dispensed shall be recovered as long as both strengths are covered benefits.

(11) Manufacturer discrepancy. Where the brand of drug billed is more expensive than the brand of drug dispensed, the difference in the allowable cost between the brand billed and the brand dispensed shall be recovered; except when the brand billed was not stocked by the provider; 100% of the ingredient cost and professional fee, if any, paid shall be recovered.

(12) Lowest Cost Drug Discrepancy. Where the brand of generic drug billed was not the least costly brand of that generic drug stocked in the pharmacy or clinic with a special permit at the time of dispensing the difference in the allowable costs between the brand paid and the least costly brand stocked shall be recovered. No recovery will be sought where a prescriber prohibits substitution as provided in Section 4047.6 of the Business and Professions Code and as provided in Section 51513(a)(14) of these regulations.

(13) Dosage Form Discrepancy.

(14) Prior Authorization Requirements. 100% of the ingredient cost and professional fee, if any, shall be recovered under any of the following circumstances:

(15) Code I prescriptions. Unless prior authorization was obtained, 100% of the ingredient cost and professional fee, if any, paid shall be recovered where the drug dispensed is not in compliance with the Code I restrictions in Medi-Cal regulations.