Home Forums Discussions General Discussion HELP PATIENT FRAUD!

We have our first case of fraud that we were tipped off too, by a pharmacist.

We have a patient who came to us for the first time and asked for adderall to be prescription. So our doctor gave it to her.

The pharmacist called at a later date saying there was way to many suspicious factors and a MAPS was pulled (Michigan Automated Prescription System) turns out she has filled 2280 30mg adderall pills since march 22, 2011, this is not including the 120 she was just trying to fill from us.

The MAPS shows she was using 3 other doctors (not including us) and used i believe 15 different pharmacies to get these adderall prescriptions filled. She would use medicare or cash pay to pay for these.

This just screams fraud! But how do you get someone like this arrested? She is 56 and somehow has medicare which is paying for these! It is so ridiculous! I called priority health and reported it. A pharmacist was suppose to call, but even after a second call the next day still no response.

I just have no idea how you get this stopped! Please if anyone has had similar experience or knows what to do let me know.

We also want to protect ourselves from any kind of "claim" against that the patient may raise.

Thanks!

We do not make the actual determination of fraud, we'll allow the state patrol to do this after giving them the appropriate information.

What authorities do you report this too?

Thanks!

In Ohio we call the police as well as the state pharmacy board inspector. They are very good at getting on it right away.

It is not illegal for a patient to go to multiple doctors and pharmacies. Although it should be when it is obvious fraud.

In Washington State (not DC) we have the
Washington State Prescription Monitoring Program

The Prescription Monitoring Program (Prescription Review) is a patient safety tool. Practitioners have access to the information before they prescribe or dispense drugs. The information provided allows a practitioner to look for duplicate prescribing, misuse, drug interactions, and other potential concerns. By having this information available before prescribing or dispensing, a practitioner can provide improved care to their patients.

Providers have to establish an account in order to get access. It became effective in January 2012.

However, it is considered a felony when a patient alters a prescription and you would contact your local authorities.

Perhaps your state has a similar program.

On how to stop it from happening again we send the patient an official discharge letter sent via certified mail. Notify all other providers in our office of this patients name and drug(s) of choice. We also notify all local pharmacies and other providers the patient has been treated by of the situation. Once word gets out they are going to have to travel further away to maintain their habit.

And for any new patients we require them to provide us with old records where they were actually prescribed any addictive or narcotic medications. We also don't prescribe more than a 30 day supply at a time and make them come in on a regular basis for refills.

Hope this helps some.

I agree with Robynne. When a new patient comes to the office and they request ritalin or adderal, I will tell them I need records and give them a 30 day supply. If they we get no records they get no Rx. If they do not follow up in a reasonable time 30-60 days they will not get a refill, for they must have missed an appointment.