Pharmacy Scams


The attached two faxes are part of a real pharmacy scam.  The patient and doctor identifiers have been blocked out. The name of the pharmacy is left intact.

Here is how the scam works.  The pharmacy uses readily available databases to identify patients with diabetes.  They claim they call the patient or get them to provide info from an online survey.  The pharmacy then faxes a request to the patient’s doctor requesting a prescription for diabetic supplies.  That’s just the start…

The doctor assumes this is the patient’s appropriate pharmacy and everything is legitimate. Then, the pharmacy goes for the real money grab.  On the same diabetic supply request, the pharmacy adds a series of overpriced supplements.  In this particular example, the pharmacy tacked on a prescription for fish oil with a pre-checked box.   A previous fax from the company on this same patient had a high priced ($800 or more)  version of a lidocaine-capsaicin-etc. compounded pain cream which has been documented as no better than placebo (https://www.sciencedaily.com/releases/2019/02/190205102542.htm).

Tricare, started tracking the problem years ago and realized it had already been bilked out of $1.5 billion.  It’s still trying to stop it all.
https://www.military.com/militaryadvantage/2018/09/27/tricare-recoups-280-million-so-far-compound-drug-scams.html

Next, the doctor’s office receives authorization requests for expensive, overpriced and unnecessary back and knee braces.  
 
This particular fax caught my eye because it included an address and voice number, which is rare for such requests.  Typically, there is only a fax number. I did call the company and got a carefully worded explanation claiming the patient requested the prescriptions (the patient denied this).  They asked if I still wanted to approve the expensive arthritis cream.

Here is the problem with this scam: Everything is legal.  It is all insanely misleading and overpriced, but it is legal.  The pharmacy requires a doctor’s signature and the drugs are not dispensed until the doctor is tricked into signing the faxed prescription.  There are no financial kickbacks. No prescribing doctor is getting money.  There is no crime in the legal sense.

If you file a complaint with the Texas Board of Pharmacy, where this company is based, you are greeted with apathy.  If you complain to the insurance company, they are not interested. If you call Medicare, you get nowhere.  I’ve tried….So…. the scams continue and only a vigilant doctor’s office can stop this.

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Steven Mussey MD

Steven Mussey, M.D. is a physician in Internal Medicine, practicing in the Fredericksburg area for more than twenty years. He grew up in Springfield, Virginia and earned a degree in Physics from The University of Virginia, Phi Beta Kappa. He earned his medical degree at The George Washington University and was inducted into the medical honor society AOA. He is Board Certified in Internal Medicine. He served in the Air Force for four years before entering into private practice. He particularly enjoys geriatric medical care and working with complex patients. For almost a quarter century, he has been practicing with one other Internist. Both doctors enjoy practice in a small, but busy office, and plan on working into their 70s, as long as they can still find their way to the office. Dr. Mussey is also an avid cartoonist and has a weekly cartoon in the local newspaper. He also enjoys cartoon animation and has had several public service cartoons playing regularly on the television cable systems. 

  9 comments for “Pharmacy Scams

  1. Philip Clarke
    January 15, 2020 at 6:52 pm

    Could you put incorrect provider and prescriber numbers and erroneous details for the patient (Medicare, insurance etc) and reply. That way the pharmacy will be out of pocket and soon learn not to hassle you. You could put something in 6 point type “this is not a valid prescription” if you think the lawyers might get uppity?

  2. Mark Peterson
    January 15, 2020 at 5:13 pm

    This will always be a problem in any system where someone *else* pays for the service besides the recipient. If patients paid directly, with their own money, this would go away, and the stuff that is requested and necessary would be reasonably priced thanks to …wait for it… the free market and competition. Need proof? Take a quick glance at the prices of wrist splints and test strips on Amazon.

  3. Kurt
    January 15, 2020 at 3:47 pm

    I have noticed the stuff going on for years. Knee braces, back braces, capsaicin cream and supplements. When in doubt, phone the patient. This stuff was so flagrant I never fell for a single refill..

  4. Aaron M Levine
    January 15, 2020 at 2:34 pm

    two issues with which I agree. I was on a medication for 2 weeks after surgery last summer. I keep getting calls from the pharmacy to pick up my 3 month refills. I have met with the head pharmacist, and that has not changed.

    I also got faxes for a back brace. One of my patients answered an ad for a free back brace. I did not feel he needed it. The company demanded I sign the prescription. They threatened me by telling me that they would tell my patient that I did not care about him. He later told me they sent him a bill for the free brace since I would not prescribe it.

  5. Jennifer Hollywood
    January 15, 2020 at 2:12 pm

    I have also noticed a new pharmacy trick for refills. The pharmacy will request a refill on a medication about a week after filling that medication. That way they always have a prescription to fill (and charge the patient for). They don’t care if the patients ever keep appointments or follow up with the physician. Proper management of medical conditions is no longer relevant to the pharmacist. They just want to get that sale. It’s such a waste of time sorting through these abusive requests for medicine refills. They promote poor medicine and have the potential to increase medication errors.

    • R Stuart
      January 15, 2020 at 3:37 pm

      “It’s such a waste of time sorting through these abusive requests for medicine refills”

      See below. Take requests ONLY from patients.

  6. R Stuart
    January 14, 2020 at 11:29 am

    We’ve trained our front desk to put all faxed requests – for scripts, DME, whatever – straight in the circular file.

    If the patient wants/needs something, they can call us.

    • deborah sutcliffe
      January 14, 2020 at 3:35 pm

      Moving to this method too! Patient contacts doctor to obtain refills.

      • R Stuart
        January 14, 2020 at 3:54 pm

        We did a one-month study in our office.

        73% of faxes from pharmacies requesting refills were wrong: patient no longer on that med, no longer our patient, had missed multiple visits, wasn’t rx’d by us, already had refills, had died, had moved away etc etc.

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