Preventing doctor shopping and other forms of prescription fraud in California
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A pertinent problem in the Golden State’s health care system is prescription fraud, as Californian professionals were responsible for about 3.9 million filled prescriptions in 2011. As defined in California Health and Safety Code 11173 HS, there is a form of prescription fraud where a person tries to access a prescription for controlled substances by using fraud, deceit or concealing a fact about oneself that would otherwise prevent a prescriptive remedy. This is a process informally known as “doctor shopping”. Popular drugs of choice for these individuals are antidepressants like Prozac, anti-anxiety medications such as Valium and painkillers like Vicodin.

Various sources have cited extreme and notable cases of doctor shopping, such as actor Corey Haim who accrued approximately 553 doses of prescription drugs shortly before his death. What makes matters worse is that doctor shopping is not the only racket the state has encountered.

For example, there is also another form of prescription fraud that points the finger at clinicians instead of patients. This happens when a medical professional, who is authorized to fill out prescriptions, writes them for controlled substances not in accordance with their practice or without legitimate medical purposes altogether. A common case is that a doctor builds up a reputation among drug seekers for having a “no questions asked” policy when it comes to writing prescriptions, perhaps even charging a flat fee per visit.

According to David Brushwood, professor of pharmaceutical outcomes and policy at the University of Florida, doctor shopping is not the only issue facing the worlds of treatment and recovery. He said, “It’s a relatively insignificant source of diverted prescription drugs, as compared with theft from drug stores, warehouses, acquisition over the Internet [and] theft from people’s homes.”

California’s current checks and balances against fraud

Any example of prescription fraud, regardless if the patient or clinician is at fault, may be charged as either a misdemeanor or a felony under California law, depending on the prosecutor’s discretion and other relevant factors such as the individual’s criminal history. Misdemeanor prescription fraud is punishable by up to one year in county jail while felony-level fraud has the potential to sentence someone between sixteen months and three years in jail. Also, a convicted medical professional convicted will most likely lose his or her license to practice from that point on.

However, in order to reach this legislative level of control, instances of fraud must be effectively overseen and identified first. A number of different prescription monitoring programs, also known as PMPs, have been implemented in multiple regions and systems. For example, one online database from California is called CURES and it provides critical and accessible information of both prescribers and dispensers all over the state. It allows pharmacists and the Justice Department to see patterns of prescription in an innovative, detailed light.

However, these programs are not without their own barriers and other shortcomings. First of all, there is a fair proportion of the medical field that does not subscribe to these new tools. Their reasons include a general skepticism of the technology’s accuracy in addition to the extra time it adds to their workloads. Also, without a nationwide consolidation of the multiple PMPs available, it makes it much harder to track fraud in a comprehensive manner. Lastly, those who do doctor shop are also experienced in using different aliases and commuting to nearby states in order to accomplish their goals.

Despite these challenges, progress is still taking place in the battle against prescription drug abuse and addiction. Sovereign Health of California seeks to rally the strength of the treatment field and inspire strong and effective change in areas in need of improvement. Specifically for a person recovering from a serious dependency, our seasoned staff of clinicians and mental health experts will provide a combination of options that will match the client’s exact needs. For further information, chat with a consultant online or call (866) 819-0427.

Written by Lee Yates, Sovereign Health Group writer

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