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How to detect prescription fraud in pharmacies

What is Prescription Fraud and How to Identify It?

Prescription fraud in Pharmacies is not new. It’s been going on for more than a decade and costs the taxpayer, yes you, millions every year. Judging by the scale of the problem, it’s obvious that current systems aren’t equipped to counter it, nor do they have the sophistication to identify it.

How to detect prescription fraud in pharmacies

What is Prescription Fraud in Pharmacies?

Prescription fraud is defined as the “Illegal acquisition of prescription drugs for personnel use (abuse) or profit through forging, altering (altering stolen prescription), getting multiple prescriptions to increase quantity.

Basically, any forged prescription used to obtain medication through deception is prescription fraud. According to an article in Global New Canada the Ontario Drug Benefit Program, among other government programs, falls victim to it regularly.

The article, written in 2019, features an interview with a private contractor who regularly cooked the books for over 100 pharmacies. He disguised transactions to prevent Health Ministry Audits from catching overbilling.

How Big of a Problem is Prescription Fraud in Canada?

According to the same article above, the Ontario Drug Benefit Program costs taxpayers $5.4 billion just in the province. However, this is a problem throughout North America. According to the National Healthcare Anti-Fraud Association, the losses from prescription fraud could be in the tens of billions of dollars.

So, the question now is, how can you identify and stop prescription fraud? The answer is more complex than you might think.

How to Identify Prescription Fraud in Pharmacies?

Prescription fraud identification is more complex to solve than with a single phone call. The Ontario College of Pharmacists suggests a long list of forgery reporting and management strategies. This includes:

  • Using a delaying tactic to stall for time to frustrate perpetrators
  • Notifying the police when the suspect is in the pharmacy, or even after they have left
  • Note the suspect’s description and note which direction they are travelling in if they leave. Also note the suspect’s vehicle number, color, and make.
  • Preserve evidence of the prescription by either retaining it or making a copy of it. If you can, store it in a plastic Ziploc bag to preserve the fingerprints.

Now, if this sounds like an episode of CSI to you, you’re not alone. There is also the fact that a lot of medication is ordered online. You can’t implement any of these steps on the internet, can you? So, what are the other viable steps to identify prescription fraud?

How to detect prescription fraud in pharmacies

Assessing Prescription Details in Relation to the Information Gathered

According to the Ontario College of Pharmacists, checking the prescription against the patient is a good place to start. If the dosage, dose regimen, and quantity are very reasonable in relation to the symptoms, prescriptions are likely authentic.

Large quantities of medications and high frequency doses usually mark forgeries. These types of forgeries are more likely to occur in newly opened pharmacies, or during rush hours. Holidays and weekends when regular staff are not on duty are usually fertile grounds for these kinds of forgeries.

Pharmacists can gather relevant information through dialogue and document details about patient records. They should also observe body language, a person’s behavior, etc. to provide clues about potential forged prescriptions.

Authentication of Prescriber Details

An effective way to check if the prescription is authentic is to go straight to the source. Looking at physician’s records can identify forgeries. For example, the volumes of prescriptions originating from a physician or a clinic, or even a hospital can raise red flags.

Also, looking at the types of medication prescribed can also help. Excessive prescriptions for tranquilizers, painkillers, and narcotics can help identify forgeries.

This was a major problem which caused the opioid epidemic in North America. At its peak, the dispensing rate in the US was 81.3 prescriptions per 100 persons. Not only will marking physicians for excessive prescriptions limit fraud and expenses, but it will also help save lives.

Check Frequency of Patient Visits

Finally, checking the frequency of patient visits is an invaluable source of authentication. If patients frequently visit pharmacies to get medications, they can be perpetrators of prescription fraud.

Not only that, but these patients may also need help if they are abusing medications.

The Truth About Identifying Prescription Fraud in Pharmacies

Constant vigilance is required to catch the myriad instances of prescription fraud, and that goes against common human error.

The truth is that there is no substitute for a network which identifies and authenticates genuine prescriptions from forgeries.

This doesn’t just require a vast storage for prescriptions, but also immutable and tamper proof record keeping.

A network of storage and credentials which can identify physicians, health and medical institutions, and patients, is the solution. Without such a network, there will always be cracks to slip through. With a network for authentication, there is at least the possibility that forgeries will be caught by the system.

Instead of relying on human intelligence and common sense, a system of automatic checks and balances can trigger identification. Such a system does exist. It’s called Blockchain. It’s a decentralized system which can authenticate information and store genuine records without danger of hacks or forgery.

Implementing such a system can effectively minimize prescription fraud in Pharmacies. The problem is, not every pharmacy has it.

Luckily for you, PlusVirtual has just what you need.

PlusVirtual is Dedicated to Eliminating Prescription Fraud

PlusVirtual is dedicated to protecting your prescription information and eliminating forgeries. We have established a tight network of communication between physicians and drug dispensaries. Our latest updates even include Blockchain storage, so that your prescription details are immutably stored in our system.

When it comes to your health, go with the name you can trust. Go with PlusVirtual.