Pharmacists are highly educated professionals who sometimes find that their career isn’t as satisfying or rewarding as they had hoped during school, which can lead them to make questionable decisions to increase their income.
Like general practice physicians, pharmacists go to school for many years in order to practice their chosen career. They use all of that training in the proper dispensation of medication and controlled substances for patients with a valid prescription from a licensed physician. Wage stagnation and corporate competition have made pharmaceutical careers less rewarding than they once were.
Many people don’t think of pharmacists when they imagine medical insurance fraud, but pharmacists, just like dentists and physicians, can find themselves facing fraud allegations due to insurance billing practices or questionable dispensation practices. Reviewing some of the red flags for pharmacy fraud can help you evaluate whether your practice is at risk of future pharmacy fraud allegations.
Have you accepted questionable or fraudulent prescriptions?
Tracking prescriptions and verifying their validity is an important part of the job. Individuals can engage in drug-seeking behavior for a number of reasons. In some cases, the motivation is a physical and psychological dependence on a drug. Patients may attempt to present multiple prescriptions from multiple doctors, steal prescription paperwork that they fill out on their own behalf or even alter an existing prescription in the hope of obtaining more medication.
As a licensed professional, you have knowledge related to the appropriate dosage and dispensation of controlled substances, particularly those with the potential for abuse. If you ignore common sense and fill a prescription that seems potentially falsified without verifying it with the issuing physician, there could be consequences for you in the future.
Have you dispensed less than you claimed or substituted another drug?
As in any industry where someone has direct contact with customers, a pharmacist can eventually become aware of particular clients that may not use all of their medication or be particularly fastidious in its consumption or storage.
Some individuals might take advantage of that lack of care by shorting a prescription several pills. They will believe that the patient will not notice the shortage, thus allowing them to retain the medication or sell it to someone else. A similar form of fraud could involve dispensing a lower dosage of a medication than was prescribed or you bill for, or replacing a brand name prescription that you bill their insurance for with a cheaper generic substitute.
These are just a handful of examples of behaviors that could result in fraud allegations against the pharmacist or technician working in a pharmacy. Close monitoring of your businesses practices can help protect you from issues that could lead to charges.