Angela Lee Diversion Investigators DRUG ENFORCEMENT ADMINISTRATION Jackson, Mississippi

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1 DRUG ENFORCEMENT ADMINSTRATION Guide to Prescription Fraud &Diversion

2 Angela Lee Diversion Investigators DRUG ENFORCEMENT ADMINISTRATION Jackson, Mississippi

3 Office of Diversion Control Regulatory and Administrative Responsibility Investigative Responsibility for enforcement of the Unites States Code (criminal or civil) and the Code of Federal Regulations

4 DEA s Dual Role Maintain closed system of controlled substance and listed chemical record keeping... Conduct investigations on the diversion of controlled substances and listed chemicals into the black market...

5 WHAT IS DIVERSION THE DIVERTING OF LEGITMATE CONTROLLED SUBSTANCES or LISTED CHEMICALS INTO THE BLACK MARKET; GOVERNED BY FEDERAL LAW/DEA AUTHORITY; ALSO GOVERNED BY STATE LAW;

6 CONTROLLED PREMISES DEFINITION controlled via CFRs DEA AUTHORITY CONTROLLED PREMISE AND REGISTERED LOCATION ARE THE SAME

7 PRESCRIPTION REFILLS SCHEDULE 3, 3N,4, 4N, AND 5 ORIGINAL Rx WITH 5 REFILLS IN A 6 MONTH PERIOD IS ALLOWED PRESCRIPTION CAN BE TELEPHONED

8 Controlled Substance Dispensing vs. Administering Federal Requirement - Follow state laws and regulations DEA Registration must concur with state authorized activities...

9 Acquiring by Fraud, Deceit, etc. Forged Prescriptions Altered prescriptions False called in prescriptions Doctor Shopping /acquire large amounts The attempt establishes criminal intent and is a chargeable crime

10 Types of Fraudulent Prescriptions Stolen Rx Pads (Charity Hospital, etc.) Altered Rx s Altered physician call back number False call-in Rx s by suspects Computer generated Rx s atsuspects home

11 INDICATIONS THAT RX S ARE NOT LEGITIMATE AMOUNT HIGHER THAN USUAL REFILLS ARE BEING ACQUIRED SOONER THAN THE AMOUNT IS PRESCRIBED FOR SUSPECT PRESENTS RX S IN THE NAMES OF OTHER PERSONS

12 CHARECTERISTICS OF FORGED RX S RX LOOKS TOO GOOD / TOO LEGIBLE QUANTITIES OR DOSAGES DIFFER FROM USUAL MEDICAL DOSAGES RX DOESN T HAVE THE USUAL ABREVEATIONS RX APPEARS TO BE PHOTOCOPIED RX WRITTEN IN DIFFERENT COLOR INKS OR APPEAR TO HAVE DIFFERENT HANDWRITING

13 Title 21 United States Code Illegal distribution 841(a)(1) Illegal Dispensing for registrants using their professional authority to participate, aid and assist in the diversion of pharmaceuticals

14 Title 21 United States Code 843(a)(3) Acquisition of Controlled Substances by Fraud, etc; Federal law may not be applied below minimum threshold amounts; State t law will apply in most cases since each state can effect laws that are more restrictive ti than the federal law - Constitutional Sovereignty

15 Possession of Rx Form For a Controlled Substance or Legend Drug; Legend Drug is one which is not controlled, o but requires es a Rx to be filled Verify Ownership Suspect must have the express consent of the person in whose name the Rx was written for...

16 PAIN MANAGEMENT PRACTITIONERS ARE NOT LIMITED LEGITIMATE MEDICAL PURPOSE *STATED TREATMENT GOALS AND FOLLOW-UP DEA INVESTIGATIONS DR. SHOPPERS/ OBTAINING BY FRAUD SCAMS

17 Myth of the Chilling Effect Vast Majority of Practioners Comply with rules and regulations DEA Investigations are based on facts determined from said investigations... Since FY 1999: Approx. one million registered doctors - DEA has had sanctions pursued upon less than one tenth of 1%...

18 NTP S RELIEF OF PAIN METHADONE SUBJECT TO HIGH ABUSE SCHEDULE II 40mg Diskettes voluntarily removed from marketplace due to abuse provided only to NTPs; Not FDA approved for pain mgt.

19 NTP GUIDELINES FOR M.D. S 3 DAY RULE ADJUNCT TO MEDICAL TREATMENT ADMINISTERED NOT PRESCRIBED Buprenorphine products can be prescribed or administered by authorized physicians

20 INTERNET PRESCRIBING DR. / PATIENT RELATIONSHIP SUBJECT TO ABUSE NEGATIVE PUBLICITY LICENSURE IN ALL JURISDICTIONS WHERE PATIENTS ARE LOCATED

21 POTENTIAL HEALTH RISKS IN INTERNET PRESCRIBING Adverse drug reactions/interactions Misdiagnosis or delay in diagnosis Failure to identify complicating conditions

22 WHERE TO GATHER INFORMATION FOR INVESTIGATION RX FORM REQUIREMENTS RX BOTTLE LABELS VERIFY SUSPECT STORY/MAKE TELEPHONE INQUIRIES FACE TO FACE INTERVIEW WITH PHYSICIAN AND STAFF WHEN POSSIBLE INTERVIEW OF PHARMACIST AND STAFF WHEN POSSIBLE

23 On Scene Investigation Do the basics of verifying Rx with physician Get statement from pharmacist and physician Verify DEA Registration Number Get actual RX form for evidence from pharmacy Verify handwriting (handwriting exemplar) Get written disclaimer on Rx form from DR.

24 Acquiring Documentary Evidence at Pharmacies Subpoena Deuces Tecum from District Attorney s Office Pres. Monitoring Prog. Ask for DEA assistance if possible - Service of Notice of Inspection Grand Jury Subpoenas Always provide a receipt for any documents taken as evidence; return documents upon completion of prosecution...

25 Common Characteristics of the Drug Abuser Unusual behavior in the waiting room Assertive personality, often demanding immediate service Unusual appearance, extreme slovenliness or over dressed d May have unusual knowledge of controlled substances or gives medical history with textbook symptoms or gives evasive or vague answers to questions on their medical history

26 Characteristics Continued Reluctant or unwilling to provide information, usually has no regular doctor or health insurance, pays in cash Will request specific controlled substances by name, and won t try a different drug\ Has no interest in diagnosis, fails to keep appointments, t refuses to see a specialists May exhibit mood swings, suicidal thoughts, lack of impulse control

27 MO Used by Drug Abusers Must be seen right away, anxious, nervous Wants an appointment at the end of the day Calls or comes in after regular hours Traveling through town, visiting friends or relatives, not a permanent resident Feigning physical problems, such as abdominal or back pain, kidney stones, migraine headaches

28 MO Continued Feigning psychological problems, anxiety, insomnia, fatigue or depression States that specific non-narcotic narcotic analgesics don t work or they are allergic to them Claims to be a patient of a practitioner who is not available or they will not give the name of their primary physician

29 MO Continued Claims a prescription has been lost or stolen Requests early refills Pressures the practitioner with sympathy or guilt or direct threats t Uses a child or elderly person when seeking methylphenidate or pain medication

30 What to do When Confronted by DO: a Suspected Drug Abuser Perform a thorough examination appropriate to the condition Document examination results and questions you asked the patient t Request a picture ID and social security number, photocopy and keep in medical file Call a previous practitioner, pharmacist or hospital to confirm the patient s story

31 DO Continued Confirm telephone number of patient Confirm current address of patient Write Wit prescriptions for a limited it amount Limit refills

32 What not to do DON T Take the patients word for it Dispense drugs just to get rid of drug seeking patients Prescribe, dispense or administer controlled substances outside the scope of your professional practice or in the absence of a practitioner-patient patient relationship

33 Responsibilities Legal and ethical responsibility to uphold the law and protect society from drug abuse Professional responsibility to prescribe and dispense controlled substances appropriately Personal responsibility to protect t your practice from becoming easy target

34 Potential Penalties Letter of Admonition Civil Fines Ci Criminal i lp Prosecution Revocation

35 For Further Information, contact the: Jackson District Office Diversion Group Contact Us at: (601) or jg