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By Mindy Hsu
Start in Middletown, New York.
Police arrested two men attempting to fill a 180-pill prescription for 30 mg oxycodones. The Pharmacist checked, learned that the script had already been filled twice, and called the police. Officers found 17 more copies and a list of drugstores when they grabbed the fraudsters. So, 180 times 20 is 3,600. Street value? Six figures! A quick jaunt to Camden, New Jersey. Another fraudulent prescription, and another eagle-eyed pharmacist. This time the customer was using a fake name. Having pulled it off once before, she returned to the same place and tried it again. All she got was two charges of “obtaining a controlled dangerous substance by fraud and possession of a controlled dangerous substance” and a trip to the County jail.
Moving over to Wauwatosa, Wisconsin.
Missing. A 100-count bottle of 40 mg oxycontin. A Walgreen’s pharmacist was not amused and immediately called police to report the thievery of the powerful drugs.
Now where? How about Beaufort, North Carolina.
An employee of a medical practice was using stolen prescription pads and writing her own orders for hydrocodone and alprazolam (Vicodin and Xanax) to the tune of more than 2,500 doses in the past year. What’d she get? How about … charged with 18 counts of obtaining a controlled substance by fraud, 21 counts of obtaining a controlled substance by false pretense, and 17 counts of trafficking opium.
Or to Henrico, Virginia
This time it was Percocets and the perp (Perpocets?) was a doctor shopper who added the element of a high-resolution photocopier and trips to several surrounding cities to her agenda.
And to Bakersfield, California
Where sentences were handed out to participants in a horrific scheme of “convenience drugging” of Alzheimer’s patients in order to quiet them down so that employees had an easier time handling the really noisy and disruptive ones. The drugs were legal; the arbitrary dosing was not. One patient died.
Over to Orange County, California
An oncologist was convicted of having billed insurers for hundreds of doses of chemo medications that were never delivered. In acts of God-play, he decided which of the 100 patients’ got the 25 courses he’d actually ordered and which got plain saline — while he billed all 100 insurance plans for the costly real stuff.
Back east to Phoenix, Arizona.
A staged auto accident ring was paying participating injured passengers” by dispensing pain-killers that could easily be traded for cash on the street corners. And they were. Then finally, for now, the state of Texas. The state’s coffers are increased by approximately $36 million, representing its share of Medicaid/Medicare recovery of ten times that amount. Two large pharmaceutical companies reported by a Florida whistle blower made the payments.
All frauds.
All … all over the place.All involving pharmaceuticals.
Pharmacy/pharmaceutical fraud knows no borders. It ranges from relatively small cases, where the crooks are individuals who either abuse the drugs themselves or sell them on the streets to anybody willing to pay for them, to organized criminal cartels or mega-businesses seeking to increase profits.
It doesn’t stop at Little Town, USA, either.
The former owner of a Canadian Internet pharmacy is facing a four-year prison sentence for selling counterfeit medications in 2005 and 2006. Plenty more companies are being scrutinized due to reports of fake erectile dysfunction meds, bogus ADHD drugs and even phony cancer medications. Generics can be particularly dangerous because some fakes contain potentially habit-forming drugs or dosages that range from far below to far above that of brand names. Little blue pills from China, where quality control may be anything but, can be little blue pills … or …?
Ethical pharmacists, and the vast majority are ethical, fight back by scrutinizing prescriptions and running them through databases before dispensing the drugs. The industry has responded with the installation of state-run programs that track individuals and medical providers, seeking out cases of doctor shopping or other abuses. (Still to be accomplished is the ability for a Laughlin, Nevada, pharmacist to share information with a Bullhead City, Arizona, pharmacist.) Industry is also bringing in nano-printing, tracking systems, and more as they fight to keep up with often lifethreatening cases of pharmacy fraud.
Pharmacists are doing their part in many ways; however, fraud poses a huge problem to individuals, to affected businesses, and to the overall economy. For the most positive effect and outcome, a joint effort between multiple agencies is necessary. Two rather specific examples of areas where increased monitoring, communication, and guidelines could result in a significant difference are:
- The dispensing of items for patients with diabetes (testing strips, monitors, etc.), and for individuals who must use catheters or other similar supplies. Television and other media are rife with commercials offering medical consumers the opportunity to provide a Medicare ID number in exchange for a “we’ll handle everything” approach. There exists little control as to quantities provided (is the patient really using 200 testing strips in any given time period?) and even less cross-referencing control if the patient no longer requires the supplies, receives them through another source, or even dies. At what cost is this to the system?
- The self-policing of pharmacies and pharmacists is counter-productive. While corner drugstores are a disappearing convenience, the expectation that a self-employed pharmacist will slash his own financial throat by officially reporting suspicions about his largest account (for instance the owner of a nursing facility) are unrealistic. Survival instincts can easily influence both judgment and follow-up action. Pharmacists should be part of the solution, not depended upon to be all of it.
The following list includes many of the practices that licensed pharmacists have implemented: • Communication with doctors and other pharmacists fraudulent activity.
- Improving screening by checking prescriptions, checking ID and detecting suspicious behavior.
- Education of the doctors in the food chain above and patients in the food chain below.
- Making it more difficult for fraudsters (ID checks, call-backs to verify, medical license checks, etc.)
- Employing security measures (securing prescription pads, tamper-free items, etc.)
- Moving to electronic systems of prescription ordering.
- Encouraging legislation to make way for more prosecutions, more convictions — and stronger sentences.
- Implementing prescription monitoring programs to help identify problem areas.
- Curbing distribution by imposing limits and structured systems.
- Ensuring/facilitating compliance with the law. Encouraging NA, drug treatment programs, drug court, rehab.
- Inter-industry cooperation. Forming relationships with police agencies, medical boards, insurers, etc.
- Database creations to share information.
Mindy Hsu, PharmD, MBA is a registered pharmacist and volunteer consultant to FightFraudAmerica.com.