The Most Common Prescription Fraud Scams
Prescription fraud is a big problem that costs taxpayers, insurers, and consumers billions of dollars every year. From small-time schemes to steal a few pills, to massive criminal enterprises trafficking in fake or stolen drugs, prescription scams come in many forms.
In this article, we’ll break down the most common prescription fraud tactics so you can protect yourself and your loved ones.
Doctor Shopping
Doctor shopping refers to seeing multiple doctors to obtain duplicate prescriptions for controlled substances. Patients get prescriptions from several doctors, who don’t know the patient is getting meds from others, and then fill them at various pharmacies.
This allows the patient to obtain more pills than appropriate. The extra pills may be used recreationally or sold illegally. Signs of doctor shopping include:
- Frequently changing doctors and pharmacies
- Travelling long distances to fill prescriptions
- Using multiple names or insurance cards
States now monitor prescriptions through prescription drug monitoring programs to crack down on doctor shopping.
Pharmacy Fraud
Dishonest pharmacists and techs sometimes steal pills right from the shelves. They may remove a few pills from each bottle so the theft is harder to detect. The stolen pills are then sold on the black market.
In other cases, pharmacy staff bill insurers for meds that are never actually dispensed. This generates fraudulent profits from the reimbursement payments. One study found over 500 cases per year of pharmacists arrested for prescription fraud.
Forged Prescriptions
Criminals try to get prescription drugs by altering legitimate prescriptions or writing completely fake ones. Common techniques include:
- Stealing blank prescription pads
- Creating realistic fake scripts
- Changing information on real prescriptions
- Copying signatures from doctors
Pharmacists are trained to spot signs of alteration or forgery. States also provide access to databases of recent prescriptions to verify legitimacy.
Identity Theft
Stolen personal information from data breaches is sometimes used to fraudulently obtain prescriptions. Imposters use the victim’s name and insurance to get meds prescribed and filled.
This is often done with mail-order or online pharmacies where no photo ID is required. The drugs may then be sold or used by the scammer while the victim gets stuck with the bill.
Pill Mills
“Pill mills” are sham clinics that prescribe opioids without a legitimate medical purpose. Patients are often recruited and paid to pose as pain patients to get oxycodone and other controlled substances.
The ringleaders then sell the pills illegally at huge markups. Fentanyl, a dangerous synthetic opioid, is also increasingly prescribed at pill mills.
Medicare & Insurance Fraud
Scammers overbill Medicare, Medicaid, and private insurers for meds that patients don’t need or never receive. This generates big payouts from the fraudulent claims.
Some schemes involve kickbacks to shady doctors who write unnecessary prescriptions. Others use stolen patient data to bill for fake prescriptions. Losses to health care fraud top $100 billion per year.
Counterfeit Drugs
Fake prescription drugs are manufactured to look like the real thing, but may contain incorrect doses, impurities, or no active ingredients at all. They are sold online, in foreign countries, or on the street.
Taking counterfeit medication is dangerous. At best, it won’t treat the condition. At worst, it could cause a bad reaction or overdose. Customs agents seize millions of dollars in fake pills annually.
Protect Yourself from Prescription Fraud
While law enforcement cracks down on large-scale schemes, individuals also need to take precautions. Steps you can take include:
- Inspect your medical bills for errors
- Check prescription monitoring reports annually
- Use mail-order pharmacies cautiously
- Never share or sell prescription medications
- Store prescriptions securely
Being vigilant protects you and prevents pills from being diverted and misused illegally. If you suspect fraud, report it to local authorities or Medicare’s fraud hotline.