Fake prescription checklist

[Roto]

Hey everyone -- I have a favor to ask of the collective genius and experience here at SDN. 🙂

This is partly inspired by finishing the "The Checklist Manifesto" by Atul Gawande (check it out if you haven't already).

I ask that you share one piece of information that is different from those already shared that you feel is important to identifying and resolving a situation with a fake prescription (the emphasis is on written C-II). As more people share we will have a compiled, concise list of tips that we can all benefit from.

Please copy and paste the list into your reply before adding to it

I'll start
- Sig is written out (instead of common abbreviations)
- Unusual directions
- Condition and Qty don't match (e.g. Dental procedure and #120 Percocet)
- Qty, medication, refills look tampered with
- Prescription is missing security elements
- Customer comes in right before closing
- Large qty of medication w/out insurance and paying cash
- Paper doesn't feel/look right (appears purposefully folded, wrinkled to appear old/used)

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[type b pharmD]

Hey everyone -- I have a favor to ask of the collective genius and experience here at SDN. 🙂

This is partly inspired by finishing the "The Checklist Manifesto" by Atul Gawande (check it out if you haven't already).

I ask that you share one piece of information that is different from those already shared that you feel is important to identifying and resolving a situation with a fake prescription (the emphasis is on written C-II). As more people share we will have a compiled, concise list of tips that we can all benefit from.

Please copy and paste the list into your reply before adding to it

I'll start
- Sig is written out (instead of common abbreviations)
- Unusual directions
- Condition and Qty don't match (e.g. Dental procedure and #120 Percocet)
- Qty, medication, refills look tampered with
- Prescription is missing security elements
- Customer comes in right before closing
- Large qty of medication w/out insurance and paying cash
- Paper doesn't feel/look right (appears purposefully folded, wrinkled to appear old/used)

Not quite a "red flag" but sometimes on suspicious scripts the Dr signature or dea does not match with the checkbox for provider (on group practice pads) . Sometimes its a mistake or perhaps an intern or covering Dr but it is another thing you can check if suspicious

 

[Roto]

Not quite a "red flag" but sometimes on suspicious scripts the Dr signature or dea does not match with the checkbox for provider (on group practice pads) . Sometimes its a mistake or perhaps an intern or covering Dr but it is another thing you can check if suspicious

Thanks for the reply -- please copy and add your response to the list (I already did). Good suggestion!

- Sig is written out (instead of common abbreviations)
- Unusual directions
- Condition and Qty don't match (e.g. Dental procedure and #120 Percocet)
- Qty, medication, refills look tampered with
- Prescription is missing security elements
- Customer comes in right before closing
- Large qty of medication w/out insurance and paying cash
- Paper doesn't feel/look right (appears purposefully folded, wrinkled to appear old/used)
-Dr signature or dea does not match with the checkbox for provider (on group practice pads)

 

[WVUPharm2007]

The professionals are disgustingly talented and you can throw all of these out the window with them. I've seen prescriptions on freaking thermal ink pads that looked 100% legit that were fake. No idea HTF they did it. Some serious mafioso stuff.

At this point, in this day and age, you should really assume every script could be fake. Every new patent, you need to call. And you don't call the number on the script. Those end-level boss forgers will put their number on the script and "nurse" with some pretty convincing clinical knowledge might be on the other end telling you its all just fine. This has happened before. To my pharmacy. Totally blew my mind. Use the number in your computer. And when you talk to them, confirm the RX and get a diagnosis.

 

[Roto]

Good info, I read through your thread 😉 Thanks!

 

[Ackj]

The professionals are disgustingly talented and you can throw all of these out the window with them. I've seen prescriptions on freaking thermal ink pads that looked 100% legit that were fake. No idea HTF they did it. Some serious mafioso stuff.

At this point, in this day and age, you should really assume every script could be fake. Every new patent, you need to call. And you don't call the number on the script. Those end-level boss forgers will put their number on the script and "nurse" with some pretty convincing clinical knowledge might be on the other end telling you its all just fine. This has happened before. To my pharmacy. Totally blew my mind. Use the number in your computer. And when you talk to them, confirm the RX and get a diagnosis.

I heard of a story a while back (who knows, maybe I read it here) where somebody hacked the system and changed the address of a few physicians, so when the ordered more official Rx pads, the blanks were sent to wherever the forger specified. So they had a big supply of actual official blanks with all of the security features to play with.

 

[crazybob]

Missing a stamp that the office usually puts on prescriptions.

It could be difficult if it's the first script you've seen from the prescriber and it was missing that particular feature.

 

[Wheresmyaricept]

Emergency room prescriptions for more than a short term supply on controls usually throws up a red flag.

 

[BenJammin]

Don't forget doctor information that doesn't match up to what you already have in the computer. But I think the biggest sign that a script is wrong is that it makes you feel weird filling it. All of the fakes I caught were ones that just looked odd to me. Nothing in particular stuck out...they just looked odd.

 

[type b pharmD]

I guess another semi obvious but common situation is a script written for a nonexistent strength , like oxycodone 100mg or percocet 50/325 , have seen a few funny ones like this before.

 

[Roto]

Great info thanks!

What do you all do when you suspect a fake script??

 

[Lnsean]

Hey everyone -- I have a favor to ask of the collective genius and experience here at SDN. 🙂

This is partly inspired by finishing the "The Checklist Manifesto" by Atul Gawande (check it out if you haven't already).

I ask that you share one piece of information that is different from those already shared that you feel is important to identifying and resolving a situation with a fake prescription (the emphasis is on written C-II). As more people share we will have a compiled, concise list of tips that we can all benefit from.

Please copy and paste the list into your reply before adding to it

I'll start
- Sig is written out (instead of common abbreviations)
- Unusual directions
- Condition and Qty don't match (e.g. Dental procedure and #120 Percocet)
- Qty, medication, refills look tampered with
- Prescription is missing security elements
- Customer comes in right before closing
- Large qty of medication w/out insurance and paying cash
- Paper doesn't feel/look right (appears purposefully folded, wrinkled to appear old/used)

seriously, this list is useful in catching noobs who don't know what they're doing; the things on here may had been useful 10 years ago. These days, I've seen scripts printed on non-erasable scripts with all the security features..the numbers routing to a person who is waiting to say "yes...script is legit..DR SO&SO saw him this morning." This list is so full of noobness

 

[zelman]

I'd start with the list here

 

[tkim]

I'd start with the list here

http://www.deadiversion.usdoj.gov/pubs/brochures/pharmguide.htm

"Characteristics of Forged Prescriptions

Prescription looks "too good"; the prescriber's handwriting is too legible;"

This is why my rx writing looks like I smashed my hand on the counter before I wrote it, I want it to look legit.

 

[Roto]

seriously, this list is useful in catching noobs who don't know what they're doing; the things on here may had been useful 10 years ago. These days, I've seen scripts printed on non-erasable scripts with all the security features..the numbers routing to a person who is waiting to say "yes...script is legit..DR SO&SO saw him this morning." This list is so full of noobness

So when you are presented these scripts what do you do? How do you know they are fake or do you?

 

[Roto]

http://www.deadiversion.usdoj.gov/pubs/brochures/pharmguide.htm

"Characteristics of Forged Prescriptions

Prescription looks "too good"; the prescriber's handwriting is too legible;"

This is why my rx writing looks like I smashed my hand on the counter before I wrote it, I want it to look legit.

I thought the provider had a partial stroke or borrowed a squiggle writer lol 🙂

 

[genesis09]

The key is to know your prescribers. A lot of times, you just can tell something is not right. I have seen a number of fake rx on tamper proof paper, and I wonder, how do they do that?

 

[Pharmgrlnxdor]

This isn't something you can see on the script but:

A person who wants to wait right by the counter the entire time you (or the tech) enter the script.

A person who wants to wait right by the counter the entire time you (or the tech) enter the script....and then abruptly decides to wait in the car.

A person who is overly talkative, complimentary, or just plain really nice as you are entering the script. Half of all fake scripts I see are accompanied by just such a person.

 

[Roto]

The key is to know your prescribers. A lot of times, you just can tell something is not right. I have seen a number of fake rx on tamper proof paper, and I wonder, how do they do that?

That is a good point, it can be difficult in a large city with hundreds of providers but you'll become familiar with the "usual" providers who come in for no other reason than the proximity of their office.

What computer system does your pharmacy use? Do you scan the hard copies into the system?? I'm asking because if a prescription from "Dr. Jones" looked suspect you could at that time pull up a script from Dr. Jones to compare handwriting etc. Granted, this may take some time but would be beneficial if that patient already a script from the doctor on their profile you could reference to.

Thanks for the input!

 

[Roto]

This isn't something you can see on the script but:

A person who wants to wait right by the counter the entire time you (or the tech) enter the script.

A person who wants to wait right by the counter the entire time you (or the tech) enter the script....and then abruptly decides to wait in the car.

A person who is overly talkative, complimentary, or just plain really nice as you are entering the script. Half of all fake scripts I see are accompanied by just such a person.

Great suggestions from personal experience -- thanks!

 

[Lnsean]

So when you are presented these scripts what do you do? How do you know they are fake or do you?

-short-acting chronic pain meds without long-acting ones accompanying them...they only present scripts for oxy 5mgs, 10, 15 or 30s. I usually always refuse to fill these without calling office during regular business hours and get diagnosis (ICDN9 codes too..this is what we do at my store walgreens). BTW, chronic pain syndrome is a bogus dx. Oxy 30s for knee pain is also bogus.

-I rarely fill for quantities >120 of oxys without a long-acting narc.

-scripts for chronic pain written by doctors that are not local to your pharmacy or a psych doctor writing for oxys/pain management

-they only fill for pain medications at your pharmacy (usually a red flag)

-These scripts sometimes are presented with cough syrup Prometh w/ Codiene and antibiotics. Pt will usually present u the prometh/abx scripts first and then later on come back with an oxy script as if they have all of a sudden established themselves as a trusting patient.

-Acute short-acting narcs such as percocets, I usually give the pt the benefit of the doubt. I always check the PMP (prescription monitoring program--this is in NEW JERSEY) and valid ID. I will also refuse if they show a habbit of constant ER scripts with just pain meds.

of course, then there;s the usual stuff that has been mentioned before...dont call the number on the script...blah blah....weird sigs...blah blah....new patient...someone that looks they're 19yo and getting 120 oxys...lol...must be really sick. You are paid highly to make good clinical decisions besides the usual technical check lists for a controlled prescription.

 

[BidingMyTime]

This isn't something you can see on the script but:

A person who wants to wait right by the counter the entire time you (or the tech) enter the script.

A person who wants to wait right by the counter the entire time you (or the tech) enter the script....and then abruptly decides to wait in the car.

A person who is overly talkative, complimentary, or just plain really nice as you are entering the script. Half of all fake scripts I see are accompanied by just such a person.

This....the behavior of the person will almost always be more of a giveaway, than then RX.

Back to the op:

It is so rare to see a noob RX, last 1 I was was several years ago, where the forger had a legitimate script, and then added a 2nd RX for tramadol under the legitimate one. Majority of forged scripts these day are going to look legitimate, and has been mentioned will usually have a fake dr line number for the RPH to call and confirm the fake RX.

For detecting a fake script, look at the customer. Are they out of the area? Unless you live near a major hospital like Mayo, I would be suspicious of anyone out of town. Generally, for CII's, if its an out of town pt & and out of town dr, I will call the dr to confirm. Other things to look for, the person's behavior as noted above, an offer to give you the dr's phone number if you express any hesitation about the RX, check the person's prescription history or your state controlled registry to see what kind of history they have (although if they are faking, then its quite possible other fake RX's on their profile have been filled), as much as possible know your prescribers and their prescribing ways, for a non CII controlled they may ask you to transfer the RX to a pharmacy out of town since they are in a hurry (hoping that the RPH there won't bother checking, since they aren't filling it, and the pharmacy its being transferred to will fill it assuming the original RPH already checked it.) Bear in mind, many times the good fakers will present with other non-controlled RX's, antibiotics, psychotropics, blood pressure medicines to give more of an air of legitimacy (and unlike the guy from ER who just wants the Norco and not the penicillin, the fakers will buy all the medicines.)

Something I've see several times, fake RX's with a real dr who did his residency in-state, then moved out of state. It's certainly harder to track a dr who's in a different state, which I guess the faker's are counting on. But yeah, if the last number in your system for the dr is a hospital, and the operator tells you dr so and so hasn't been there for 5 years since they finished their residency, most likely the RX is a fake.

 

[zelman]

FYI, if you have an Rx written/printed on NY blanks with serial numbers, you can call the phone number on the back during normal business hours and find out to whom the blank was issued.

 

[Roto]

-short-acting chronic pain meds without long-acting ones accompanying them...they only present scripts for oxy 5mgs, 10, 15 or 30s. I usually always refuse to fill these without calling office during regular business hours and get diagnosis (ICDN9 codes too..this is what we do at my store walgreens). BTW, chronic pain syndrome is a bogus dx. Oxy 30s for knee pain is also bogus.

-I rarely fill for quantities >120 of oxys without a long-acting narc.

-scripts for chronic pain written by doctors that are not local to your pharmacy or a psych doctor writing for oxys/pain management

-they only fill for pain medications at your pharmacy (usually a red flag)

-These scripts sometimes are presented with cough syrup Prometh w/ Codiene and antibiotics. Pt will usually present u the prometh/abx scripts first and then later on come back with an oxy script as if they have all of a sudden established themselves as a trusting patient.

-Acute short-acting narcs such as percocets, I usually give the pt the benefit of the doubt. I always check the PMP (prescription monitoring program--this is in NEW JERSEY) and valid ID. I will also refuse if they show a habbit of constant ER scripts with just pain meds.

of course, then there;s the usual stuff that has been mentioned before...dont call the number on the script...blah blah....weird sigs...blah blah....new patient...someone that looks they're 19yo and getting 120 oxys...lol...must be really sick. You are paid highly to make good clinical decisions besides the usual technical check lists for a controlled prescription.

Great reply, really appreciate your insight!

 

[molyhelp]

............calling office during regular business hours and get diagnosis ...............

...........I will call the dr to confirm.......

....These days, I've seen scripts printed on non-erasable scripts with all the security features..the numbers routing to a person who is waiting to say "yes...script is legit..DR SO&SO saw him this morning." .....

Calling doctor seems to be the way. So, the crook has fake phone line with fake person. My only defense now is:
Clinical knowledge.

Of course, if the prescriber is Pill Mill Doctor like the ones in Florida that was arrested, this would not work. I would have to try Walgreens and Costco's check list.

Since most doctors are honest and kind and would feel bothered with verification process, with that in mind, I always say very nicely and softly to the doctor that
.... I am sorry to bother you but with the Drug Police watching us very carefully nowadays and the DEA imposing law of Pharmacist Corresponding Responsibility, we are forced to verify that the prescription is sound and reasonable......
Pause here....the doctor will say something....Let the doctor talk, then....
..... We all want to help patient through tough and painful time from the bottom of our heart at the same time protecting our duties in the eyes of prosecutor. Those compelling reasons forced me to politely ask you to please confirm you are bona fide prescriber and have good faith examination....
Pause here....the doctor will say something....Let the doctor talk, then....
Again, with both our hearts in sync to help the patient, I am sure you understand the common practice of many forgers and fakers out there that already setup fake phone number to pretend to be you and cause you in trouble...We want to prevent you from getting investigation by the DEA and drug police so we have to politely ask you clinical questions to confirm you are indeed the real prescriber with real clinical knowledge. This practice is natural to many prescribers that I have partnered with and I am sure you are in sync with all your colleages. So, with all due respect, please give me the answer of the following question.

If patient has dry cough because of blood pressure medication, which of the following is likely the cause?
A. Amlodipine.
B. Benazepril.
C. Clonidine.
D. Diazepam.
E. None of the above.

(Updated with additional information about my clinical question)
I tried that on a prescriber once for this situation:
Weekend shift. Office closed. I got a call from a cell phone caller for Norco 10 mg, quantity 120. Cell phone signal was not clear...midway through the conversation, the phone was disconnected because of bad signal. "Prescriber" called back to pharmacy and apologized for bad cell phone signal as she was driving through mountains. I said no problem as I understood doctor was working hard on weekend to help patient in pain. At the same time because of pharmacy manager's policy, I explained that I had to call back to office with phone number from my software to verify that legality of the script. "Prescriber" replied that no one was in office and patient was in pain. At that point, I had to ask clinical question with the "prescriber" on that cell phone conversation to verify. "Prescriber" understood and agreed to have clinical question.....and the answer was: the nicest silence (phone was disconnected and doctor never called me back.)

I only reserve this clinical question for situations where I have no other way to verify the doctor. If doctor is in office and I call office based on the phone number of my software, I have done my duty to verify.

Any other clinical question I can try? Please be reasonable. Thank you very much in advance.

 

[zelman]

Calling doctor seems to be the way. So, the crook has fake phone line with fake person. My only defense now is:
Clinical knowledge....Any other clinical question I can try? Please be reasonable. Thank you very much in advance.

Always remember that there is a phone number or two for each provider on the NPI online database (though some providers will neglect to update it).

I think your clinical quiz idea is rather novel, but I'd say their specialty should be taken into account. An MD in a legit suboxone clinic might not remember much about blood pressure medications. Maybe base a question on their specialty? Addiction specialists could answer "What is the purpose of naloxone in Suboxone?" and dentists could answer "Why are children rarely prescribed tetracycline antibiotics?" as we shouldn't really expect the reverse.

 

[KidPharmD]

I think that the clinical question is likely to offend the physician more than anything. Have you ever done that to a legitimate MD?

Second, why in the world would you call the number on the RX? THAT is the most noob thing I have seen in this thread. You call the number on file with the store or with the state board, or the contact number on the NPI registry.

At least try Google if nothing else. Mismatched phone numbers are a giant red flag.

 

[pezdispenser]

If patient has dry cough because of blood pressure medication, which of the following is likely the cause?
A. Amlodipine.
B. Benazepril.
C. Clonidine.
D. Diazepam.
E. None of the above.

Obviously it's the diazepam which is why the patient also needs Roxi 30 as a cough suppressant and Soma for the muscle spasms.

One of my coworkers once tested a doctor by asking "where are the Islets of Langerhans", to which the doctor replied "I dunno, in the Bahamas??"

So I don't recommend playing games like this. Keep it professional and use an official documented checklist like the ones you posted.

 

[Wheresmyaricept]

Ever wonder if threads like these are started by the people writing fakes to see if they're doing anything wrong?

 

[BenJammin]

Fake escripts. Get ready for them.

 

[molyhelp]

I think that the clinical question is likely to offend the physician more than anything. Have you ever done that to a legitimate MD?

Second, why in the world would you call the number on the RX? THAT is the most noob thing I have seen in this thread. You call the number on file with the store or with the state board, or the contact number on the NPI registry.

At least try Google if nothing else. Mismatched phone numbers are a giant red flag.

(Updated with additional information about my clinical question)
I tried that on a prescriber once for this situation:
Weekend shift. Office closed. I got a call from a cell phone caller for Norco 10 mg, quantity 120. Cell phone signal was not clear...midway through the conversation, the phone was disconnected because of bad signal. "Prescriber" called back to pharmacy and apologized for bad cell phone signal as she was driving through mountains. I said no problem as I understood doctor was working hard on weekend to help patient in pain. At the same time because of pharmacy manager's policy, I explained that I had to call back to office with phone number from my software to verify that legality of the script. "Prescriber" replied that no one was in office and patient was in pain. At that point, I had to ask clinical question with the "prescriber" on that cell phone conversation to verify. "Prescriber" understood and agreed to have clinical question.....and the answer was: the nicest silence (phone was disconnected and doctor never called me back.)

I only reserve this clinical question for situations where I have no other way to verify the doctor. If doctor is in office and I call office based on the phone number of my software, I have done my duty to verify.

 

[molyhelp]

I think that the clinical question is likely to offend the physician more than anything. Have you ever done that to a legitimate MD?

I tried on 3 doctors so far with very respectful attitude and the nicest seductive voice I could whisper at the moment. With careful choice of words and talking from the heart as I have presented earlier, so far, the prescribers have agreed to the questions before I started asking clinical questions and the mutual respectful atmosphere was maintained to the end of the conversation. 1 prescriber was legitimate (360 pills of Norco 10mg prescribed over the phone !!!) Others were fake callers. 1 was Naturopath doctor in which case I then had to politely refuse to fill the script and asked the patient to try somewhere else. I talk from the heart of a pharmacy member who is torn between helping a patient in pain as well as avoiding investigations from Drug Police. Most importantly, I emphasized that when Drug Police investigates, the investigation will involve me and the prescriber as well. With that heartfelt attitude, I have no complain at all.

Second, why in the world would you call the number on the RX? THAT is the most noob thing I have seen in this thread.

You call the number on file with the store: You are right. I do that most of the time.

or with the state board: You are right, again. I do that most of the time.

or the contact number on the NPI registry: You are right, again. I do that most of the time.


At least try Google if nothing else.

Mismatched phone numbers are a giant red flag: True again.


Second, why in the world would you call the number on the RX? THAT is the most noob thing I have seen in this thread: Sometimes, when I look up a doctor in software at chain pharmacy, based on DEA number, I find 6 different addresses with 6 different phone numbers. My guess is that the doctor is legitimately working at many different locations. So, if this script is showing address of new office with new number, the script could be fairly guessed as 1 of 2 cases: New office or Face office. The number on this script may very well be a brand new location that is not yet verified by chain. With that benefit of the doubt and if I have a patient in pain on the weekend shift, I try to help the patient by contacting the number on the script and treat that just as if a cell phone caller just called me to give controlled substance. I feel bad that I have to refuse a patient who is in pain. I must try that non-verified number on this script (maybe new office)...a human is in pain...we have a few choices:

Choice 1: Refuse the script and let this human suffer.

Choice 2: Try the non-verified phone number and ask clinical question to verify that the doctor is not in a fake office with fake phone number.

Choice 3: Offer to sell only enough to last through weekend and after we verify satisfactorily on Monday, we will dispense the rest.


Allow me to remind us the reality: we do have a mixture of prescribers:

Some stay in 1 office forever.

Some work in many offices with many different phone numbers. Chain just cannot keep up with all the locations all of the time. Once the doctor moves to new location, the new script will have new address and phone that will not be in chain's software yet. The fact that new office address is not in chain's software does not justify refusing the script flat out. I am not going to blindly fill any script and I am not going to close my heart to a patient in pain. I carefully tread the water to find safe ground for all involved.

 

[molyhelp]

Now that we are discussing about controlled substance, I realize we have a few cases of prescribers and we need to be ready to respond for such case:

Case 1: Pill Mill Offices like the offices that were busted in Florida for hiring prescribers with real knowledge and take cash to write a script. We recognize such office and refuse. Why? Drug Police (DEA) has law about Pharmacist Corresponding Responsibility. Pharmacist go to jail if blindly fill high quantity script.

Case 2: Fake office which houses fake callers and ready to "verify" fake printed scripts. For this, we have to use clinical questions. Walgreen's checklist will not work. The fake office will tell you anything you want to hear.

For example, based on Walgreen's checklist, the conversation will go like this between pharmacy and fake doctor:

Question: Please tell me the last time you have Good Faith Examination? Today.

Question: Please tell me: Is this medication within your scope of practice? I am Internist. Yes.

Question: Please tell me: Is this medication within Standard of Care? Yes.

Question: Please give Diagnosis Code: Here. ICD-9: 12345.0

Question: Please tell me: How long to you expect the treatment to last? 1 year.

Question: Please tell me: Do you have any alternative medication for pain control? Tylenol did not work, Motrin did not work, Meloxicam did not work, and Physical Therapy did not work. Patient had car accident with broken bone and nerve damage. Only Oxycodone works.

Question: Please tell me: Do you coordinate with other clinician to manage pain? No. I don't have time.


Case 3: Prescriber that just started to cross over the line of prescribing too much controlled substance. For this, Walgreen checklists will serve as a wakeup call to the prescriber that pharmacist are now also jailed and therefore pharmacist cannot just blindly fill anything anymore. By asking questions from Walgreen's list, we will indirectly remind the prescriber about the trouble of crossing into the land where Drug Police are hounding "brave" prescriber. Hopefully, the checklist will deter the prescriber from prescribing too much because prescribing too much brings this kind of troubles. My understanding is that most prescribers are honest and trying to help patient in pain and do not know how much is too much until pharmacy calls and bother with Walgreens questions. Then, prescriber knows such quantity and such practice brings heat and therefore prescribes conservatively. Of course, with this, I do not use clinical questions because they are real prescriber with knowledge. We can only bother with those questions and document that we did our best. If another shake down happens like the arrest in Florida, we have documented that we did not just blindly fill script and we hope to avoid 80 million dollars of fine and attorney fees.


Any other case I miss? Please share. Thank you.............

 

[KidPharmD]

I tried on 3 doctors so far with very respectful attitude and the nicest seductive voice I could whisper at the moment. With careful choice of words and talking from the heart as I have presented earlier, so far, the prescribers have agreed to the questions before I started asking clinical questions and the mutual respectful atmosphere was maintained to the end of the conversation. 1 prescriber was legitimate (360 pills of Norco 10mg prescribed over the phone !!!) Others were fake callers. 1 was Naturopath doctor in which case I then had to politely refuse to fill the script and asked the patient to try somewhere else.

So you used this three times, only once on an actual prescriber (not "3 doctors") Your sample of doctors who have responded to this tactic is n=1 not n=3. The 2nd example was a criminal. The Naturopath was practicing outside of his scope of practice and you should have noted that on the Rx and then informed the patient this was not a legal Rx (and possiblly informed the board of medicine). If he was not in your state, then you should have filled the Rx.

Second, why in the world would you call the number on the RX? THAT is the most noob thing I have seen in this thread: Sometimes, when I look up a doctor in software at chain pharmacy, based on DEA number, I find 6 different addresses with 6 different phone numbers. My guess is that the doctor is legitimately working at many different locations. So, if this script is showing address of new office with new number, the script could be fairly guessed as 1 of 2 cases: New office or Face office. The number on this script may very well be a brand new location that is not yet verified by chain. With that benefit of the doubt and if I have a patient in pain on the weekend shift, I try to help the patient by contacting the number on the script and treat that just as if a cell phone caller just called me to give controlled substance. I feel bad that I have to refuse a patient who is in pain. I must try that non-verified number on this script (maybe new office)...a human is in pain...we have a few choices:

I have yet to see a physician have a phone number listed on an Rx first. At very least, this is at least listed with the phone company. Try a reverse number search to see what it returns next time. I also think that we are generally talking about Rx's for which we have a strong suspicion they are fake when they come in, otherwise we wouldn't call.

Choice 1: Refuse the script and let this human suffer.

Choice 2: Try the non-verified phone number and ask clinical question to verify that the doctor is not in a fake office with fake phone number.

Choice 3: Offer to sell only enough to last through weekend and after we verify satisfactorily on Monday, we will dispense the rest.

Choice 4: Refuse the script correctly and prevent medication from getting into the hands of an addict or drug dealer.
Having successfully done number 4 many times, I will say we must not loose sight of the consequence of filling a fake Rx other than on ourselves.

Allow me to remind us the reality: we do have a mixture of prescribers:

Some stay in 1 office forever.

Some work in many offices with many different phone numbers. Chain just cannot keep up with all the locations all of the time. Once the doctor moves to new location, the new script will have new address and phone that will not be in chain's software yet. The fact that new office address is not in chain's software does not justify refusing the script flat out. I am not going to blindly fill any script and I am not going to close my heart to a patient in pain. I carefully tread the water to find safe ground for all involved.

I would agree with the bolded statement. However, a good pharmacists intuition, along with the inital triggers of suspicion, and the fact that a new address/phone number is not in the chain software AND not in the NPI/BoM databases AND not listed with the phone company AND not discoverable anywhere else with google IS extremely suspicious and probably good enough reason to delay the filling of an Rx.

 

[Ackj]

Speaking of phone calls, here's more red flags:
-lack of 10+ option phone directory
-someone answers within 3 minutes
-the "doctor" answers the phone

Trying to become more of a glass-half-full guy, I realize that all of the things that annoy the hell out of me when I call an office to clarify would likely be absent for a fake rx.

 

[Deja]

**** i had a doctor personally calling me a few days ago saying that no one from his office can call in controlled meds anymore except for him and he will be changing his DEA number and ordering new pads b/c he had to fire 2 assistants in a row for taking money and calling in fake scripts and stealing his pads

 

[WVUPharm2007]

Fake escripts. Get ready for them.

Oh, you know it. There is a damned BOUNTY to be made by an elite coder/hacker. It will happen eventually. I can just see it now. Some site only on Tor, accepts Bitcoin. You just buy narcs like its Amazon.

 

[Gombrich12]

Who needs fake escripts? On the silk road you could have someone print any fake script you wanted to your specification on tamper resistant paper. I am curious about the technology behind surescripts. You have to imagine they are locked down to the max.

 

[oldstock]

Obviously it's the diazepam which is why the patient also needs Roxi 30 as a cough suppressant and Soma for the muscle spasms.

One of my coworkers once tested a doctor by asking "where are the Islets of Langerhans", to which the doctor replied "I dunno, in the Bahamas??"

So I don't recommend playing games like this. Keep it professional and use an official documented checklist like the ones you posted.

lol 🙂