Busting a fraudulent script — UPDATED

Posted by The *Angriest* Pharmacist as Drug Seekers, Laws, Management, Me being a dick, Stupid People, Work Sucks

Every pharmacist has been in a situation before where they have considered calling the police on a person trying to pass off a fraudulent prescription. Some pharmacists pass the buck and merely give it back to the patient rather than deal with it. Others are pretty gung-ho and do their best to see the person into the waiting arms of the authorities. I kinda go back and forth. It’s a case by case basis.

I recently got an email from someone giving out tips on how to ensure pharmacists have the best chance of busting the scam-artist. It all makes complete sense, but it may not be things that we would think of in the spur of the moment.

I’ve reposted the “scenarios” below with the permission of the author, but I have edited them somewhat to make them more clear/applicable. My thanks go out to the author — Michelle.

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Suggestion 1: Someone brings in a fake prescription. After they leave, you call the doctor and verify that this is a fake prescription. The office confirms that it is fraudulent, altered, or illegal for whatever reason and instruct you to not fill it and have the person arrested. So, you call the police, and they tell you to notify them when the person arrives and stall the scammer when they come in to pick it up. You wait…they show up. Here’s a tip…tell your employees that when the customer walks into the store and announces their name, NOT TO STARE AT HIM LIKE HE HAS THE PLAGUE!! Your behavior gives you, and your intentions, away. Scammers will pick up on this — noticing the attention and bolt.

Suggestion 2: The patient will call you to see if their prescription is ready. All fake scripts will be called on by the scammer first to “test the waters” depending on your (or your tech’s) response here dictates whether they ever come in. DO NOT ASK “What exact time will you be here?” RED FLAG. Under normal circumstances, you wouldn’t care what  exact time it was picked it up. If you ask, the person will know that the police will be there to meet them, and he/she won’t show up. This will remove the gratification you so desperately need to see the person leave your pharmacy in handcuffs.

Suggestion 3: Don’t tell them over the phone that they shouldn’t use the drive-thru. Scammers know it is easier for you to arrest them in the store, so when you tell them “Uhhhh, just come in the store, something is wrong with our drive-thru,” or “We need you to come in the store to sign something,” they will know you are lying, and they won’t show up. Another thing about this that will backfire is when they do show up and the supposedly broke drive-thru is full of customers.

Suggestion 4: For the purpose of this suggestion, we’ll call our prescription forger “Sally Smith.” If you work in a big chain, you have lots of customers. They know this — that’s why they frequent the busiest stores. You cannot possibly know all your patients by name immediately. So, let says “Sally Smith” walks into your Walgreen’s at 11:00am with a fake prescription for Xanax. She gives it to you and leaves. You call and verify that it is indeed a fake prescription. You alert all of your employees that when Sally Smith comes back in they are to call the police. You and your employees anxiously await Sally’s arrival. “Did Sally show up yet?” “Watch for Sally to some in!” Well, Sally has been at this for awhile and before showing up, she decides to call you and see how you react on the phone, most often zealous pharmacists give themselves away when trying to get someone arrested. Its 3:00pm. Sally calls “Hello, my name is Sally Smith. Is my Xanax prescription ready yet?” If the pharmacist immediately responds with “Um, YES! It is ready!” She immediately knows the jig is up because you knew who she was without checking the Will-Call-Bin or the computer system. What you should say is, “ Sally who? What’s your birthday? Okay. Hold on. Let me check…..When did you drop it off? Oh, yes, Sally, yea that’s ready for you.” This is much more believable. If they sense anything, they just won’t come in — they can just forge another one and drop it off somewhere else.

Suggestion 5: Someone comes in with a prescription that you suspect is xeroxed. Medicare/Medicaid is slowly rolling out measures to counteract forging of prescriptions like watermarks, heat sensitive ink, and separate pads for controlled drugs. Anyway, you think its copied/altered. The customer gives you or your technician the prescription and leaves the counter but walks around the store pretending to be shopping. If you, as the pharmacist, are going to hold the prescription up in the air under a light like its evidence from a murder scene to see if it is copied, here is a tip, go somewhere where the customer cannot see you do this! They will be watching/waiting. If they see this followed by you grabbing the phone in an adulterous rage, they are going to bolt. In addition, go somewhere out of the pharmacy and call on the Rx. The patient might hear their name or see you say their name and assume you are going to find out it’s fraudulent…and bolt.

Suggestion 6: If someone comes in late at night to fill a controlled substance, right before closing time, there is a reason. They know you cannot contact the doctor at that hour and you just want to go home so some pharmacists will just fill the prescription as is. Some pharmacists may decide to not fill it until they can call tomorrow and verify it. Just tell them that rather than give them the drugs or lie to them. And definitely don’t blatantly lie to them by saying something like, “The pharmacist-in-charge already left for the night and took the narcotic key with them. I can’t fill anything until she gets back tomorrow morning at 9am. You can come back then.” These types of people have usually worked in a pharmacy or are very familiar with pharmacy workflow due to the frequency of their pharmacy visits. They will know that every pharmacist has access to the narcotic cabinet and just because one pharmacist leaves does not mean that narcotics cannot be filled — how retarded does that sound? Turning away all prescriptions…yeah right! Assuming they are ignorant of the ins and outs of pharmacy is wrong, and it will keep you from catching them and seeing them punished for their crime(s).

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The readers of this post are going to have varying degrees of opinions on this matter. We can all agree that is illegal, and we discourage it. Where we will have differing opinions is on what is done after the prescription has been determined as fraudulent.
1. Some will always call the cops.
2. Some will just tear the script up and tell the patient they know it was fake and tell them to not come back to their store (and make notes in the computer on the patient’s profile).
3. Some will just write fake on it in sharpie and give it back to the patient when they come in.
4. Some will leave the script alone and tell the patient they don’t have the drug and will give the script back to them.
5. Some will call the cops and have them come pick up the fake rx and make no attempt to have the person arrested in their store.
6. Some just fax the Rx to every pharmacy/doctor in their area and then give it back to the person and see what happens when they try and go to the pharmacy down the street.

None of them are wrong, necessarily. I am a big fan of Number 6. It’s really quite humorous to hear the stories from fellow pharmacists when the person continues to peddle a forged Rx to every pharmacy in town, and they ALL know it’s fake in advance.

Some employers refuse to allow their pharmacists to call the authorities or have an arrest made within the store — as it might scar the store’s reputation or bother the other customers/patients. I think this is a punk ass cop out. But, in this case, pharmacists are restricted to numbers 2, 3, 4, and/or 6.

So, what’s the right way to handle the situation? What do you do? What have you done in the past? I realize that stories are sometimes pertinent to show what you have done in the past, but try and keep them short and to the point.

UPDATE!!!

Read the Fraudulent Prescription Writing Guidebook at:
http://deadword.com/site/stripmall/hogshire2/bottom.html
If we know the rules and tricks they pull, we can counter them.

Professional courtesy

Posted by The *Angriest* Pharmacist as Work Sucks

I got an email from “The Chick in the White Coat” asking me about professional courtesies and my take on them. She was asking about things such as the loaning of pills, calling doctors for refills, and how they have become expected of pharmacy rather than something a pharmacy does as a courtesy for patients. These things have become the rule rather than the exception.

I’ve never worked in pharmacy when these things weren’t the norm. I’m sure once upon a time, these things were done by a few pharmacists as a way to keep customers, gain new customers, and go above and beyond what was expected….as a way to expand business. Yet, now they must be done to merely keep business and ensure people are happy. I personally think it’s kind of bogus.

Loaning of Pills. I do it. We all do it at one time or another. Most pharmacy statutes allow pharmacists to dispense an “emergency” 3-day supply to a patient when a doctor cannot be contacted (and a patient had been taking the medicine for an adequate amount of time). These statues also allow pharmacists to use their professional judgment in these situations — meaning that we wouldn’t give little Timmy another bottle of Amoxicillin but we would give Grandma Johnson a few more lisinopril. Most all of us do this on a case-by-case basis. I will usually give the person three days worth if they have been on the medicine for longer than three months. If a person is a really good customer and thought of by my staff in good regard, I will give them the benefit of the doubt and front three days after only one-month of therapy. That’s not exactly fair, but me giving anyone any pills is not required by law. I personally think that the patient’s should take more responsibility in their healthcare and actually read the fucking bottle. When it says ZERO REFILLS, don’t wait until there’s 1 pill left in the damn bottle to call your doctor (or pharmacy — see below). If a patient wants a week’s worth because they are going on vacation, they are shit out of luck in my pharmacy. As a reader has said in the past (and now I say all the time): “Lack of planning on your part does not constitute an emergency for me.” You can either call your doctor’s exchange/emergency line or take your bottle to a pharmacy at your final destination. They can call your doctor from there. [It goes without saying that no one fronts controlled meds to any patient under any circumstances.]

Contact doctors for refills. Again, this has become the norm. Each morning, we all have a tech chained to the phone making the daily, “doctor calls.” I’ve handled this in a few different ways. Sometimes, I come in a little early to make the calls — before the pharmacy opens. Most MD offices open earlier, and I can get them done before my staff even arrives. Over the past 6 months or so, I’ve made a huge push to convert all of my calls to faxes. I’ve got a pretty decent relationship with most of the nurses around town (and know most of the doctors), so I’ve gotten them to either buy a fax machine or allow me to fax in refills. I still have one doc that absolutely refuses to accept faxes for some weird reason — but I am down to making only 4-5 actual calls each morning. I merely told them like this, “When I call you, I get a receptionist who makes me wait on hold before she actually inquires to what I want. Then she sends me to your extension where I have to listen to your obscenely long voicemail explaining the same thing over and over again that I hear 20 times a day — what information to leave, how to do it, and to spell everything out. Then I have to leave the message and wait for you to get back with me later in the day — at your convenience. Why don’t I just send you a fax, save my time, and you can still get back to me at your convenience. The fax will have all the info on it and will add to patient safety. It will also reduce the amount of prescriptions called in by non-medical personnel that have little to no training in medicine.” — No one has ever told me to fuck off because I’m trying to increase patient safety. I even made one trip to a doctor’s office to meet with him about it. He, of course, listened to reason — regardless of how his nurse wanted it done.

I also do my best to try and get the patient active in the process. I’ve tried telling them that, “Hearing from the patient that they need a refill usually gets them in gear,” after we’ve contact the physician once. I’ve also flat out told other patients to call the doctor themselves in instances of early refills or for refills of antibiotics and drugs that usually do not have refills for a reason. The patient’s standard response is always the same — “I just talked to them. They said you need to call.” — Well, I don’t play that game anymore. As I said above, enough of my time and my staff’s time is wasted on the phone holding for a nurse. Let’s waste your time, dear patient.  “You need to call the doctor and tell them to either call or fax me, because if I call, all I’m going to get is a voicemail line instructing me to leave a message — after I wait for 5 minutes for someone to answer the phone to transfer me to the voicemail.”

I’ve also recently installed a TTY-type device which connects me to a nearby medical group which houses something like 30 doctors. I just type my message, the doctor’s extension, and it’s done. They still get back to me whenever they damn well please, but it’s convenient and really fast. I just take the receipt-paper printout and staple it to a blank Rx and it serves as my prescription.

I still haven’t addressed the issue yet — should we be doing this? Honestly, I think not. I think that patients should take a more active role in their healthcare. I believe that when they are out of refills, rather than depending on us to loan them pills and/or call their doctor, they should call the doctor themselves and state that they need more refills. I also think that doctors should ACCEPT THIS! Many doctor’s voicemail lines boldly state, “If you are a patient, have your pharmacy call us.” — Why? I have no clue. If the doctor wants them to continue the therapy, what’s the fucking issue? I understand that the office may want to know when the last fill date was, but that can be easily ascertained by even a technician when they call in the new prescription. At that point, the nurse can note that date (to track compliance) and decide whether or not the patient is actually due for a refill based in the sig and quantity dispensed. I think the nurses can handle that much…

There will be those out there that say our loaning of pills and calling MDs for refills does a lot in terms of ensuring patient compliance. I call this a load of bullshit. If a patient is not compliant with their therapy for themselves, why should I give a flying train full of antelope shit? The answer is, I don’t. Here’s what I think. I will help those that cannot help themselves — the sick, the dejected, the broken, and the poor. I will not help those that refuse to help themselves. I will not care about you if YOU don’t care about YOURSELF. Your health should be enough initiative to remain compliance with drug therapy. You took the time (and perhaps paid the money) to go see the doctor, bring the prescription to me, and get it filled. If your compliance depends on whether or not I give you three pills and call your doctor for additional refills, not only are you pathetic, you are doomed to have poor outcomes from your therapy.

Calling all hospital pharmacists

Posted by The *Angriest* Pharmacist as Hospital Pharmacy, Just a question

I’ve gotten several questions in the past asking me about Hospital Pharmacy — referring to someone in the central pharmacy that makes the IVs, fills med carts (or Pyxis, etc), maybe does a little bit of Gent/Vanc dosing, answers questions of nurses (is Drug 1 compatible with Drug 2 in a Y-site?), and potentially runs and outpatient pharmacy for the public or employees. My experience in that field is very, very minimal. I had one rotation in a hospital pharmacy — where I pretty much filled Pyxis and made IVs for 5 weeks. I didn’t learn much beyond that. These people are usually in Community/Retail pharmacy and want to know if I would ever consider switching. They also want to know about the job in general (why they think I would know — or would be able to help them is beyond me). Nonetheless, here is how I can help. I can solicit the advice/comments from my faithful readers!

Here’s what I want to know about this side of pharmacy:

- Pros and Cons
- Pay level, vacation time, benefits (Insurance, 401k, fringe) versus community pharmacy in the same area
- Role on the healthcare team (P&T — do they care what you think/say?)
- Level of staffing of Pharmacists and Technicians (Is it adequate?)
- Responsibilities of the technicians and the role they play in the pharmacy
- Amount of work expected to be completed with respect to hours in a shift
- Respect from physicians, nurses, administrators
- Opportunity for professional development and/or career advancement
- Anything else that would help someone asking the above question

Thanks in advance. Looking forward to the discussion.

Now I’m screwed

Posted by The *Angriest* Pharmacist as Work Sucks

Well, I got myself screwed over today. There was nothing I could do about it. Essentially, a patient blackmailed me (That’s a little too harsh of a word — but it is what it is). A gentleman brought in a prescription for Metformin 500mg 2am and 3pm #qs 3months + 4 refills. For those playing along at home, this prescription is for FOUR-HUNDRED AND FIFTY tablets of Metformin 500mg. WOW.

So, I go to the shelf and see that I have a full 500-count bottle and about 10 tablets in a second bottle. After filling his prescription I would have had under 60 tablets. I called him back to the pharmacy and “leveled with him.” I told him that I have enough to fill his prescription (first mistake that opened me up for attack), but if I filled it, I wouldn’t have any tablets for any other patients until Monday afternoon. He did not have the same amount if empathy as I did for these patients-to-be. I was told to, “fill that prescription and fill it now.” I kind of backed off and tried to speak with the man rationally — he was having none of it.

Had I not told him I had enough Metformin, I would have not been in this situation — my fault. However, I still had to weasel out of the situation I created.

I offered to do ALL of the following in this order:
- Give him enough for a week and mail him the remainder. (”I don’t trust any of ‘em — USPS, Fedex, DHL — they’re all crooks!”)
- Give him enough for a week and PERSONALLY deliver the remainder. (”You’d never find my house and I might be going out of town.”) - I could give you as much as a month’s worth. (”It might be an extended vacation. No tellin’ where I’ll be.”)
- Comp the prescription cost if he just took a week’s worth and waited for the rest to come via mail or delivery. (”It’s only 10 damn dollars. What kinda favor is that?”)
- Convert him to Metformin 1000mg as well as 500mg tabs to make the same dose. (”Those damn tablets are too big — that’s why I only take these 500s”)

He did not oblige. He also threatened to move ALL of his prescriptions to another pharmacy (10 total scripts) if I didn’t fill it, in its entirety, “right then and thar.” Due to that fact, I was forced to fill all 450. However, he paid the cost and received a dirty look from me for being a stubborn ole cunt. Sounds a lot like blackmail doesn’t it?

I’m very lucky my good friends at the Medicine Shoppe were able to help me out by loaning me a bottle of Metformin to cover me through the weekend. I’ll get it back to them Monday — unlike the customer, they were more than willing to wait. I’m lucky to have that relationship with them. I’ve loaned them stuff before as well — to please a patient or make things easier. It’s a good thing.

I’ll also be increasing that order quantity in the computer…and, of course, no favors — EVER for this man. He’s out of refills and needs two to three days worth? Sorry, dude. I just can’t do it! That’s a professional courtesy — not a pharmacy requirement…

What is important

Posted by The *Angriest* Pharmacist as Just a question, Patient Education, Salutations

Who are you?

It’s a very pertinent question. It can be answered in a plethora of different ways. The way each person answers the question tells us a lot about them. It tells us where the priorities lie, what they think about themselves, their career, what they’ve done with their life, and perhaps even where they are going.

One could answer this question several ways:
I’m a pharmacist. — Tells us about a person’s career or career path.
I’m a man/woman. — Tells us of their gender role (obviously). They also think their manliness/femininity personifies them.
I’m a husband/wife. — Tells us the most important thing in their life is their relationship with their S.O.
I’m a (insert religion). — Tells us that their relationship with a higher power is important to them.
I’m a son/daughter. — Tells us they value family. They probably have a good relationship with their parents.
I’m a father/mother. — Tells us they have children and they are one of the most important things in their life.
I’m a brother/sister. — Again, tells us they value family and probably have a close relationship with their siblings.
I’m a Brother/Sister. — This one could tell us they were involved in a Fraternity and valued it and the relationships they forged from it.
I’m a [pharmacy] student. — Tells us where they want to go with their life. Their aspirations.

You see, we can learn a lot about someone with just a few words — with some assumptions and clever associations. But, what’s the most important thing about someone? That’s very easy. Do you know it?

THEIR NAME! A person’s name epitomizes who they are. If you know someone’s name, you may not know everything about them the statements above can tell us, but you have a way to get that information — an ‘in’ so-to-speak. Not knowing someone’s name — or forgetting it — can be a very embarrassing situation. I do all I can to remember the name of every person that comes into my pharmacy. I think every Pharmacist and Technician should. Not only does it help us ensure the right person gets the medicine, it lets the person know that you care WHO they are and not just WHAT they are buying or HOW much they are spending.

Do whatever you need to do to remember everyone’s name. Write it down. Say it ten times in your head while looking right at them. Take a mental picture. Do whatever works! Simply by announcing someone’s name as they enter the pharmacy pretty much guarantees you a customer/patient for life. (”Hey James [or Mr. Smith]! What’re you up to today?” — or — “Hey John! How is that new Blood Pressure medicine working?” [with respect to patient privacy, of course])  It also ensures that you will probably get the benefit of the doubt should you ever make a mistake or screw the person over by accident. That personal relationship will help make sure that cool heads prevail, and it also will assure that angry patients see you as a human, with a name, that can make mistakes. But, as a human, you are allowed to be remorseful of those mistakes and apologize….all from knowing something as simple as someone’s name.

So, readers, I ask you this, WHO ARE YOU?