How Pharmacies Detect Prescription Drug Fraud

The abuse of prescription medication has been an ongoing and serious problem in the United States in recent years. The use of opioids in particular has led to hundreds of thousands of drug overdoses and affected millions of people. In 2018, two out of three drug overdose deaths involved an opioid, a total of nearly 47,000 deaths, and about a third of these involved prescription drugs.

What is prescription drug fraud?

The abuse of prescription drugs is one of the greatest public health crises in the United States of America today. Unfortunately, abusers of prescription drugs often acquire their medication through the use of prescription drug fraud. Prescription fraud happens when a person is given medication as a result of deceptive practices. Fraud may be in the form of forged prescriptions; doctor shopping, which entails visiting multiple doctors until a patient finds one willing to prescribe a particular drug; or medical facilities that prescribe drugs unethically.

What are the signs of prescription drug fraud?

Patients

Spotting a patient who is attempting to commit prescription drug fraud can be fairly common sense. One of the most obvious signs is the type of medications the patient is seeking. If the patient has prescriptions for opioids, painkillers, and/or tranquilizers, they may be a candidate to become a victim of drug addiction, as these types of drugs are highly addictive. Care must therefore be taken to monitor these patients and check for signs of drug abuse or fraud. Multiple prescriptions from numerous doctors is a tell-tale sign of a patient who is drug-seeking rather than legitimate.

Drug seekers may also travel to many different pharmacies far from home to try to fill their various prescriptions in the hopes that they won’t be caught getting too much of the same drug or type of drug. Going through the medication at a faster pace than prescribed and seeking early refills is also a sign of prescription drug abuse.

Pharmacists also must be on the lookout for forged prescriptions. Sometimes legitimate prescription pads are stolen from a doctor’s office and used to write fraudulent prescriptions or prescriptions for fake patients. Some patients attempt to alter their legitimate prescription to make it appear that the doctor prescribed a higher dose or amount of the drug. Drug abusers may also try to get fraudulent prescriptions by listing their own or an accomplice’s phone number as the callback number for a prescription.

The DEA lists some possible characteristics of forged prescriptions as:

• The prescription looks too perfect and is more legible than a typical doctor’s prescription
• The dosages, quantities, or directions do not appear to be standard
• The prescription does not use standard abbreviations
• The prescription appears to be photocopied
• The prescription is written with more than one type of ink or more than one style of handwriting
• The directions are fully written out with no abbreviations typically used by a doctor
• A patient presents prescriptions for drugs which should not be prescribed together or which would have opposing effects, such as a simultaneous prescription for stimulants and depressants
• A patient presents prescriptions in the name of multiple people

Doctors

Doctors may also contribute to prescription drug fraud by writing unnecessary or fraudulent prescriptions. Pharmacists look out for doctors that prescribe suspiciously large volumes of prescription drugs, particularly opioids, prescription painkillers, and tranquilizers, especially to patients who don’t have a diagnosed condition that would be consistent with the drugs and/or drug amounts prescribed. Pharmacies are also suspicious when multiple people or many new patients show up at the same time with prescriptions for addictive drugs written by the same doctor.

What are the effects of prescription drug fraud?

Prescription drug fraud is a very serious problem, because prescription drugs contribute greatly to the opioid epidemic. Opioids are highly addictive drugs. Many prescription painkillers are in the same family as illegal drugs like heroin. It is not uncommon for patients to be legitimately prescribed prescription painkillers only to become addicted to them. Once addicted, a patient may either try to fraudulently obtain additional prescriptions, or if they fail to get the legitimate prescription drug, they may turn to buying street drugs like heroin in search of similar effects.

Because of this phenomenon, the use of both prescription drugs and heroin has greatly increased over the past 15-20 years. The CDC found that in 2012, doctors prescribed enough opioids to give a bottle to every adult in the country, and the majority of new heroin users were addicted to prescription opioids first.

How to Prevent Prescription Drug Fraud

Prescription drug fraud and the soaring rates of opioid use have proved difficult to combat, but there are some solutions that physicians, pharmacists, law enforcement officers, and insurance companies can implement to try to reduce the rate of prescription drug fraud and subsequent opioid addiction. Blue Cross Blue Shield implemented a plan to monitor patients and prescribers in an effort to detect addictive behavior and unethical practices. They report doctors who prescribe large amounts of controlled substances, and flag patients who obtain multiple prescriptions for controlled substances within a short time period or from multiple doctors or pharmacies.

The DEA recommends that pharmacists be familiar with their patients, make note of any suspicious amounts of new patients from the same prescribing physician, be familiar with the prescriber and his or her signature, know the prescriber’s DEA registration number, and check dates on prescriptions. Prescriptions that have not been filled within a reasonable length of time may be suspicious.

Pharmacists should call the prescribing physician for verification or clarification if there is any question about the validity or specifics of the prescription order. Pharmacies can request to see a patient’s identification to be sure the patient is in fact the person to whom the prescription was written. Pharmacists are also asked to keep an eye out for prescriptions that appear to be forged or altered and to contact the police if they are presented with a counterfeit prescription or notice a pattern of suspicious behavior among patients or prescribing doctors.