Identifying Forgeries and Fraudulent Prescriptions

FACT SHEET

Published: July 2013

Legislative References: Standards of Practice, Code of Ethics, Narcotic Safety and Awareness Act

Additional References: NarcoticMonitoring System (MOH) FAQs;

Abuse and Diversion of Controlled Substances (available through Health Canada by request));

FactSheet - Narcotic Reporting of Forgeries and Losses

College Contact: Pharmacy Practice


Background:

The most common way to gain illegal access to narcotics or controlled substances is through the use of legitimate prescriptions and forgeries. The Narcotic Monitoring System (NMS) may temporarily reduce forgeries; however, those seeking narcotics or controlled substances can be very creative in developing new methods for obtaining these drugs. Advances in technology and the sophistication of equipment such as photocopiers and faxes makes detecting forgeries or prescription copies an even more daunting task. Fax numbers and points of origin can be manipulated, making it essential for members to be able to recognize or verify the authenticity of all prescriptions.


Tips for Members in Identifying Forged or Fraudulent Prescriptions

Members should take a systematic approach to screening prescriptions before filling. The Standards of Practice provide guidance to members that can be utilized for the purpose of screening both prescriptions and patients. Checking the dose, the frequency and drug use indications are ideal starting points. Applying communication skills and observing the patient’s behaviour (e.g. nervousness, aggressiveness, failure to make eye contact) may also provide clues that indicate a potentially fraudulent prescription — especially with patients that are not known to pharmacy staff.

The measures mandated through the Narcotic Safety and Awareness Act (NSAA) may help reduce the number of forgeries of narcotics and controlled drugs; however, members should continue to remain cognizant of fraudulent prescriptions precipitated through:

  • Identity theft;
  • Selling of prescriptions;
  • Theft of prescriptions from legitimate patients;
  • Inappropriate prescribing by physicians pressured into prescribing drugs of abuse; and
  • Prescriptions that appear to originate from out of the province.

Members are also advised to follow up on alerts generated by the NMS and co-operate with pharmacies requesting information regarding these alerts.

There are a number of factors that can be assessed to determine whether a prescription is authentic or a potential forgery. Although the prescription itself is normally the main focus, assessing other elements of the transaction can also provide information useful in determining the authenticity of a prescription. Consider the following:

1. The Patient:

  • Do you know the patient?
  • Is there a patient medication history?
  • Is this medication consistent with the treatment history on file?
  • Is it reasonable for the patient to be visiting your pharmacy, given where the patient lives?
  • Is the patient on vacation or visiting a friend or relative?

2. The Prescriber:

  • Do you know the prescriber, including their practice or specialty?
  • Is it reasonable for the patient to be seeing this prescriber?
  • Is the prescriber from out of town?
  • Are the drugs prescribed tailored to the individual or do all the prescribers’ patients appear to receive the same drugs?

3. The Prescription:

  • Looks too good, i.e. handwriting, format, patient information.
  • Quantities or directions differ from the normal pattern.
  • Unusual symbols, terminology, or abbreviations are used.
  • Directions are fully written out.
  • Use of white-out, smudging, or different colour ink on prescription.
  • Alterations to quantities.
  • Spelling errors.
  • Prescription appears to be a photocopy and not an original.
  • For electronically generated prescriptions, font size is different from normal.

4. Suspicious Situations:

  • Patient is in a hurry and unable to return later.
  • Patient presents the prescription late in the evening, or on weekends, when it’s difficult to confirm Rx with doctor.
  • Date prescription written is not consistent with urgency to fill the prescription.
  • A diversion is used to distract the member and pressure them to fill the Rx as quickly as possible, e.g. crying baby or feigned illness.

Members are advised to develop and implement routine dispensing procedures that reflect the standards of practice. Compromises or shortcuts may lead to errors in judgement

Practices That Help to Reduce the Potential for Fraud

Where there is any question regarding the validity of the prescription, take the time to conduct due diligence and verify the authenticity of the prescription directly with the prescriber.

  • Verify that the practitioner exists (e.g., check for listing in telephone book or contact the College of Physicians and Surgeons of Ontario (CPSO) to confirm prescriber’s coordinates) and is treating the patient. If possible, know the prescriber’s signature.
  • Contact CPSO where there is no contact information listed in the registry.
  • For out of province prescriptions, contact the licensing body of the prescriber for that province.

Do Not Rely on Your Computer Verification

A drug-seeking individual may have been successful in his or her first attempt to obtain drugs at your pharmacy by fraudulent means, and may therefore have a record in your system, or he or she may have brought a legitimate prescription into your pharmacy on the first occasion so that he or she has a valid patient record. If in doubt, verify any prescriptions that seem out of context or suspicious directly with the prescriber.

Do not be Fooled by "Third Party Insurance"

The Ontario Drug Benefit Card, Worker’s Compensation, etc. presented by a patient may be legitimate, or it may be stolen or otherwise invalid. Do not automatically fill a prescription just because a patient has one of these cards. Verify the prescription as usual.

Take the Prescription Out of Circulation

When there is suspicion that a prescription may be forged, it is recommended that the pharmacy contact information be added to the prescription or complete the patient's information (e.g. address, phone number, etc.) on the prescription; this way, if there is an attempt to fill the prescription at another pharmacy, that member will be alerted to the potential fraud. Likewise, if a prescription with another pharmacy’s stamp on it is received, it is recommended to contact the other pharmacy before filling.

Patient Identification

Under the NMS, pharmacists are expected to record the number and type of identification provided by the prescriber on a prescription for a monitored drug. List of acceptable identification can be found at
http://www.health.gov.on.ca/en/public/programs/drugs/ons/publicnotice/identification_list.aspx

In the case of an agent picking up a prescription for a patient, identification of the agent must be recorded and maintained by the pharmacy.

For more information pharmacists are directed to the Ministry website at http://www.health.gov.on.ca/en/pro/programs/drugs/ons/ons_faq.aspx

For more information on the Narcotic Monitoring System please visit http://www.health.gov.on.ca/en/pro/programs/drugs/ons/about.aspx

If You Identify a Forgery

  1. Use a delaying tactic, such as stalling for time is a good tactic as it generally frustrates diverters who are usually in a hurry. Contact the police so that they can be present upon the suspect's return.
  2. Do not physically restrain the suspect. This may jeopardize you, your staff or a customer. If possible, when the suspect leaves, and if he or she is driving, note the vehicle licence number, type and colour of the car, and direction of travel.
  3. Notify the police. Use the emergency number 9-1-1 if the suspect is still in the pharmacy and advise the person receiving the call that the suspect is still in the pharmacy. Otherwise, report the offence to the police (refer to your local directory) and report the incident to the Officeof Controlled Substances, Drug Strategy and Controlled Substances Programme at Tel: (613) 954-1541, Fax: (613) 957-0110.
  4. Optional: Fax a copy of the Forgery Report to the Ontario College of Pharmacists at (416) 847-8292
  5. Preserve the evidence. Always retain the prescription if possible. Minimize handling the prescription to preserve finger prints left by the suspect. If possible, place it in a plastic baggie. If you feel your safety may be jeopardized and the suspect demands the return of the prescription, comply with his or her request.
  6. Advise physicians to contact the Ontario Public Drug Program Division (OPDP) to report stolen prescription pads or notify OPDP when they become aware of forged prescriptions using their name.

CONTACT INFORMATION

College of Physicians and Surgeons of Ontario
Tel: 416-967-2600, Toll Free:1-800-268-7096
www.cpso.on.ca, select “Dr Search”

Office of Controlled Substances
Tel: 613-954-1541
Fax: 613-957-0110
Forgery Report Form:
http://www.hc-sc.gc.ca/hc-ps/substancontrol/substan/compli-conform/loss-perte/forgery_rep-rap_fau_ordonnace-eng.php

Ontario College of Pharmacists
Tel: 416-962-4861 ext. 2210
Fax: 416-847-8292 (Optional: Send copy of Forgery Report Form to OCP)
OCP Fact sheet - Narcotic Reporting of Forgeries and Losses