Doctor shopping and insurance fraud and asshat patients — OH MY!
Man, these folks are coming out of the woodwork!
Had a lady call me for a refill (on we'll say 3/19) on her (surprise) Norco 10/325 last week because she was (surprise) going out of town. It had been 9 days since we had refilled it. The prescription was for 50 tablets taken every 6 hours. I put it in as a 13 day supply. I told her that it would be "a few more days" before it could be filled. She, of course, did not agree with me. She tried to tell me that it was a 12-day supply and we, meaning my pharmacy, "always fill it three days early." Well, she's wrong...maybe two days early...on a 30 day supply...if the patient isn't a problem....
The fact that she argued with me about filling it early, about it being a 12 day supply versus a 13 day supply, and told me what MY pharmacy always does got me interested in her profile.
I booted up my trusted internet browser and navigated to my state's Prescription Drug Monitoring Program, plugged in her information, and I was quite shocked at what I found.
Date Drug Qty/Days Prescriber Filled by:
3-14 Hydrocodone/APAP 10/325 90/30 J. Smith CVS
3-14 Alprazolam 1mg 90/30 J. Smith CVS
3-10 Hydrocodone/APAP 7.5/325 50/13 B. Jones MY PCY
3-10 Alprazolam 0.5mg 30/10 B. Jones MY PCY
And this shit continued for the last 3 months or so. Let me share the most SHOCKING piece of information -- there was another column titled "Payee" which will say Medicaid, Commercial, or CASH. Usually, we would expect this to say CASH at one pharmacy and COMMERCIAL or MEDICAID at the other when we encounter doctor shoppers. In this instance, THEY ALL SAID COMMERCIAL!!!
This lady was doctor shopping using her insurance card...from her benefits at work! WOW! I can only assume the insurance company didn't catch it because the strengths had different NDC -- maybe even different manufacturers? Not sure....
I called and confirmed all of this with my friend Remy at CVS, and we each canceled all of her refills. I then printed all of this out and faxed it to the physicians involved (and every pharmacy in town). I heard back from both offices very quickly -- and they were pissed. They canceled the refills (of course) and each fired her as a patient.
When she called back the next day, it was precious. She said, "Well, will it go through today? It's been 10 days and it's a 12 day supply." I said, "No, it's still a 13 day supply, and it has come to our attention that you have been getting the same drugs in different strengths at CVS."
"That's just not true!"
"Oh, yes it is. And this has been going on for several months now."
"Well.......(long, awkward pause)......how do I fix this? I'm not sure I know what's going on...."
"Well.......yesterday, I fixed it by faxing this information to both doctors and every pharmacy in town. The doctors then called me back and canceled all remaining refills and wanted me to let you know you were released as a patient. Now, what they are going to do? I don't know. For your sake, I would hope they don't call the police because it appears crimes have been committed here..."
"Eck..." [Really odd sound she made here. I'd say it was the sound of disbelief.]
"If you really and truly have no idea what's going on, you need to call and talk to CVS and both of these doctors immediately...." [I said this in a really shitass tone]
"Okay. Thank you very much!" [Being nice...praying *I* don't call the police]
I’d rather have…
New t-shirt design inspired by a comment. The commenter suggested a shirt saying something to the effect of "SUPPORT INDEPENDENT PHARMACY." While this shirt doesn't necessarily say that, I believe the concept is similar. For those of you in retail, take no offense. It's a joke...where do you think I work now? To see the image in a better detail, check out the image on ZAZZLE.
If you want to see the entire gallery of shirts, you can click the Zazzle link in the frame to the right. The CafePress link has a wider selection of the shirts bearing the same images/sayings/logos if you want something exotic (like hoodies, underwear, or girly spaghetti strap shirts)
Have a suggestion? (other than me going to hell and/or shutting the fuck up) Contact me.
Unfortunately, this is a TRUE story
I swear on the life of my unborn children that the following conversation is almost 100% exactly as it happened. Right as it concluded, I went and recorded a "note" on my iPhone to help me remember this idiocy...
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"I was wondering, if I brought a list of my medicines up here, could you tell me how much each of them would cost?"
"Are you on file here? And do you have insurance?"
"I've never been here before, but I have Paid insurance."
"Well then, unfortunately, I cannot. Your best be would be to look on the back of your card and call the Member Services or Customer Service number listed there. They can tell you exactly how much each prescription will cost. All I can give you here is the cash price which doesn't do you any good when your insurance will foot the bill in most cases."
"I don't understand. Can't you just put it in the computer and see?" [Gotta love that all-powerful, "computer" that does all and knows all!]
"That's not how it works. If I had valid prescriptions on file for each one, I certainly could just push a button or two and tell you, but you aren't on file here. So, I can't do anything to help you. If you'd rather bring me a stack of prescriptions I can get you prices then..."
"Well. That doesn't make any sense. I've got a list at home with all the prices on it. Why can't you just tell me what they cost? You're a pharmacist!"
"Wait. You have a list of all the medicines, what they cost, and you want ME to tell you what they cost? You want me to tell you what that list already says?"
"Noooo....well, not exactly. You see, at the last pharmacy I went to they gave me special prices on some medicines. Not the expensive ones. They ran those [the expensive ones] on my insurance, but there were some that were cheaper if they didn't use my insurance."
"Are you talking about the '$4 list' generics?"
"Yeah! That's it. How much are those here?
"Well, they are $4...we honor that program. Unfortunately, I don't have them all memorized, but if you bring in what you got, I can figure it all out."
"Well, I've got a list of the ones that are $4 at Wal-Mart at home. Don't you have that list?"
"Wait. You have the list of what your prescriptions cost on your insurance at home. You ALSO have the list of ALL the $4 prescriptions at home. But, you want to bring me a list of your prescriptions. You want me to look at those two lists that you have at home in your possession and tell you what those lists, that you have in your possession, say. And you want me to compare those two numbers and tell you which is cheaper."
"Exactly. Which is cheaper HERE..."
"Really? ..........[Long Pause of disbelief].......... Sure...bring everything you have to me...I've got nothing better to do. I'll show you how to do one and we'll see if you can get it from there....If not, I'll get you a quote."
What he got from our conversation: That nice pharmacist will put my prescriptions in the computer and tell me what they cost if I bring him a list.
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