Melanie,
When I see a "new" patient on my schedule that looks sketchy, I check his ER visit record, make a "Narc-check" call to one of the chain pharmacies and if he's a seeker, walk in and spill the facts right up front. I give him an exit strategy: leave now, no charge, don't come back. No income, but little wasted time. Harsh pruning up front has given me an enjoyable patient population. You'd be surprised how fast Mr. Loser will spread the word to not waste time on my office.
Dave
