Fraudulent and Illegitimate Prescriptions Wrongful Conduct Rule
n previous issues, we have examined different types of controls and policies that will help keep your pharmacy free of diversion. Most of those tips and suggestions focused on preventing and detecting in-house diversion by employees. In this edition, we will take a closer look at how to identify and manage diversion by customers using fraudulent prescriptions or by prescribers who issue prescriptions without a legitimate medical purpose. As always, developing a policy and procedure and training your employees on how to properly handle suspected fraud should be your first step. But what should be in your policy? The number one way to prevent illegitimate prescriptions from being filled at your pharmacy is a close assessment of the prescription itself. The DEA suggests that any of the following characteristics are a red flag that warrant further investigation before dispensing the prescription: • An unfamiliar prescriber • A prescription that looks like it may have been altered or copied • A prescription that is unusually legible • Quantities or instructions that are different than usual medical practice • Different colored inks or different handwriting • No abbreviations are used • A familiar prescriber, but unfamiliar handwriting (someone may have stolen the prescription pad) • A familiar prescriber’s name, but different phone number or address The next step is an objective assessment of any potential red flags about the patient or the prescriber. In its manual for pharmacists, the DEA suggests considering the following as warning signs: • The prescriber writes significantly more prescriptions (or in larger quantities) compared to other practitioners in the area. • The patient appears to be returning too frequently. A 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. • The patient presents 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. 16
• People who are not regular patrons or residents of the community, show up with prescriptions from the same physician. The full DEA guide to prescription fraud may be accessed at http://www.deadiversion.usdoj.gov/pubs/manuals/pharm2/ appendix/appdx_d.htm. If any of the above assessments reveal a possibly fraudulent prescription, your next step should be to check the Arkansas Prescription Drug Monitoring Program (APMP) database records on the patient and/or the prescriber, at http://www. arkansaspmp.com/. If you don’t yet have an account, you can initiate setting one up at http://www.arkansaspmp.com/ practitioner-/-pharmacist/. Through the PMP check, you can monitor the following red flags for a patient’s history: • Using multiple prescribers for controlled drugs • Same controlled drug prescriptions consecutively written by different prescribers • Multiple pharmacies • Prescribers from another city or state If any of the above assessments raise concern about the legitimacy of the prescription, you should contact the prescriber’s office directly to confirm the prescription, the diagnosis, and that the prescription is within the prescriber’s scope of practice. Finally, what do you do if you have determined that a prescription is a fraud? You should not fill it. If you believe the prescription has been forged, you should also contact your local law enforcement immediately and keep the hard copy there. It is also a good practice to contact law enforcement proactively to seek advice on how they would like this situation to be managed—your local agency may have additional requests for more effective prosecution of this crime. In the next issue, we will answer some of the readers’ legal questions surrounding the day to day practice of a pharmacist. § ________________________________________________________
About the author: Erika Gee represents clients in government relations, regulatory and compliance matters at Wright, Lindsey & Jennings LLP. She previously served as general counsel to the Arkansas State Board of Pharmacy for 6-1/2 years and as Chief of Staff and Chief Deputy Attorney General for Attorney General Dustin McDaniel. She uses her experience as general counsel for state agencies and licensing boards to assist clients to resolve regulatory and disciplinary disputes with state government.
THE ARKANSAS PHARMACIST
ARRX - The Arkansas Pharmacist Summer 2016