Pharmacist’s Guide to Prescription Fraud

The purpose of this guide is to ensure that controlled substances continue to be available for legitimate medical and scientific purposes while preventing their diversion into the illicit market. It is not the intent of this publication to discourage or prohibit the use of controlled substances where medically indicated. DEA supports the 1998 "Model Guidelines for the Use of Controlled Substances for the Treatment of Pain" prepared by the Federation of State Medical Boards of the United States, Inc. DEA believes that the "Model Guidelines" will protect legitimate medical uses of controlled substances while preventing drug diversion.

Nothing in this guide should be construed as authorizing or permitting any person to conduct any act that is not authorized or permitted under Federal or state laws.

The abuse of prescription drugs—especially controlled substances—is a serious social and health problem in the United States today. As a healthcare professional, you share responsibility for solving the prescription drug abuse and diversion problem.

You have a legal responsibility to acquaint yourself with the state and Federal

requirements for dispensing controlled substances. You also have a legal and ethical responsibility to uphold these laws and to help protect society from drug abuse.

You have a personal responsibility to protect your practice from becoming an easy target for drug diversion. You must become aware of the potential situations where drug diversion can occur and safeguards that can be enacted to prevent this diversion.

The dispensing pharmacist must maintain a constant vigilance against forged or altered prescriptions. The law holds the pharmacist responsible for knowingly dispensing a prescription that was not issued in the usual course of professional treatment.

This guide will help you meet these responsibilities.

The practiced forger of prescriptions is usually very adept at the job. The forger knows what information is needed on the prescription to make it appear authentic. Pharmacists should be aware of the various kinds of forged prescriptions that may be presented for dispensing.

Some patients, in an effort to obtain additional amounts of legitimately prescribed drugs, alter the physician’s prescription. They will also have prescription pads printed using a legitimate doctor’s name, but with a different call back number that is answered by an accomplice to verify the prescription. Also, drug seeking individuals will call in their own prescriptions and give their own telephone number as a call back confirmation.

Legitimate prescription pads are stolen from physicians’ offices and hospitals and prescriptions are written using fictitious patients names and addresses. In addition, individuals will go to emergency rooms complaining of pain in the hopes of receiving a controlled substance prescription. The prescription can then be altered or copied to be used again. Computers are often used to create prescriptions for nonexistent doctors or to copy legitimate doctors’ prescriptions.

Note: The quantity of drugs prescribed and frequency of prescriptions filled are not alone indications of fraud or improper prescribing especially if the patient is being treated with opioids for pain management. Pharmacists should also recognize that drug tolerance and physical dependence may develop as a consequence of the patient’s sustained use of opioid analgesics for the legitimate treatment of chronic pain.

The following criteria may indicate that a prescription was not issued for a legitimate medical purpose.

The prescriber writes significantly more prescriptions (or in larger quantities) compared to other practitioners in your area.

The patient appears to be returning too frequently. Prescription which should last for a month in legitimate use, is being refilled on a biweekly, weekly or even a daily basis.

The prescriber writes prescriptions for antagonistic drugs, such as depressants and stimulants, at the same time. Drug abusers often request prescriptions for "uppers and downers" at the same time.

Patient appears presenting prescriptions written in the names of other people.

A number of people appear simultaneously, or within a short time, all bearing similar prescriptions from the same physician.

Numerous "strangers," people who are not regular patrons or residents of your community, suddenly show up with prescriptions from the same physician.

1. Prescription looks "too good"; the prescriber’s handwriting is too legible;
2. Quantities, directions or dosages differ from usual medical usage;
3. Prescription does not comply with the acceptable standard abbreviations or appear to be textbook presentations;
4. Prescription appears to be photocopied;
5. Directions written in full with no abbreviations;
6. Prescription written in different-color inks or written in different handwriting.
7. Apparent erasure marks.

Know the prescriber and his/her signature;

Know the prescriber’s DEA registration number;

Know the patient;

Check the date on the prescription order. Has it been presented to you in a reasonable length of time since the prescriber wrote it?

When there is a question about any aspect of the prescription order, call the prescriber for verification or clarification. Should there be a discrepancy, the patient must have a plausible reason before the prescription medication is dispensed.

Any time you are in doubt, require proper identification. Although this procedure isn’t foolproof (identification papers can also be stolen/forged), it does increase the drug abuser’s risk.

If you believe that you have a forged, altered, or bogus prescription--don’t dispense it--call your local police.

If you believe that you have discovered a pattern of prescription abuses, contact your State Board of Pharmacy or your local DEA office. Both DEA and state authorities consider retail-level diversion a priority issue.

Dispensing procedures, without control and professional caution, are an invitation to the drug abuser. Proper controls against bogus prescriptions can best be accomplished by following common sense, sound professional practice, and proper dispensing procedures and controls.

Have your pharmacy staff help protect your practice from becoming a source of prescription drug diversion. Become familiar with which drugs are popular for abuse and resale on the streets in your area. Drug abuse prevention must be an ongoing staff activity.