From: Diana King Handwriting Expert , Diana King : 785-309-0997
Prescription Forgery
By Diana G King; RN, LNC, FDE;
www.DianaGKing.com
● Anatomy of the "Legitimate Prescription"
Regardless of state, a prescription for a controlled substance must include the following information:
- Date of issue,
- Patient's name and address,
- Practitioner's name, address
and DEA registration number,
- Drug name,
- Drug strength,
- Dosage form,
- Quantity prescribed,
- Directions for use,
- Number of refills (if any) authorized, and
- Manual signature of prescriber.
Figure
1
- Sample "Legitimate Prescription" Components
A prescription must be written in ink or indelible pencil or typewritten and must be manually signed by the practitioner. An individual may be designated by the practitioner to prepare the prescriptions for his/her signature. The practitioner is responsible for making sure that the prescription conforms in all essential respects to the law and regulation.
Prescriptions for Schedule II controlled substances must be written and be signed by the practitioner. In emergency situations, a prescription for a Schedule II controlled substance may be telephoned to the pharmacy and the prescriber must follow up with a written prescription being sent to the pharmacy within seven days. Prescriptions for Schedule III through V controlled substances may by written, oral or transmitted by fax.
A "DEA number" is a series of numbers assigned to a health care provider (such as a physician, nurse practitioner, or physician's assistant) allowing them to write prescriptions for controlled substances. Legally the DEA number is solely to be used for tracking controlled substances. The DEA number, however, is often used by the industry as a general "prescriber" number that is a unique identifier for anyone who can prescribe medication.
A valid DEA number consists of:
·
2 letters and 7 digits
·
The first letter is either an "A" or a "B"
·
The second letter is the initial of the registrant's last name
·
The seventh digit is a "checksum" that is calculated as follows:
o
Add together the first, third and fifth digits
o
Add together the second, fourth and sixth digits and multiply the sum by 2
o
Add the 2 above numbers
o
The last digit (the "one's" value) of this last sum is used as the seventh digit in the DEA number
Note: Each state's Administrative Code (Pharmacy Practice and/or Medical Professions) can and does delineate the specific prescription format (physical characteristics such as paper, size, security measures, etc.) for that state. Examiners are encouraged to visit their respective local government websites and/or obtain a hard copy of these legislative documents for reference.
● Commonly Seen Prescription Forgery/Alteration Tactics
Prescription forgeries can be executed in any number of ways. The following examples are those the document examiner is most likely to encounter.
·
The easiest way a prescription is forged is for the person to simply add refills to the prescription where the physician may have forgotten. Altering the number of refills is also common.
Figure 2 - Refills changed from "1" to "4"
·
Often, the number of dosage units is modified on an existing prescription to increase the number. For example, a zero can be added to the number 12 to increase the dispensing number to 120. White-out is sometimes used to remove the dispensing number or even the name of the drug.
Figure 3 - Quantity changed from "12" to "120"
·
Another tactic is to otherwise alter the strength of the drug being dispensed. In this case, Tylenol # 2 (with 15mg Codeine) was changed to Tylenol #4 (with 60mg Codeine – now a Schedule II)
Figure 4 - Strength of Tylenol (with Codeine) changed from "II" to "IV".
·
Another way of modifying a prescription is to add an unscheduled controlled drug (such as alprazolam) to a bona fide prescription for a non-controlled drug. For example, frequently a drug seeker diagnosed with a dental abscess who receives a prescription for an antibiotic will add a narcotic analgesic (pain reliever) to it.
Figure 5 - Addition of pain-relieving medication to prescription
The advent of scanners and color laser printers has opened up many possibilities in the world of prescription forgery. A prescription can be scanned and reproduced to create a perfect duplicate of the original. Additionally, the doctor's signature is also scanned, and can be printed onto the script using an ink cartridge printer. That way, the signature smudges when wiped with a finger!
Drug seekers have been known to steal prescription blanks from doctors' offices. Some creative con artists have even printed their own supply of prescription pads with a fictitious physician name, address, and phone number (of their own). When a pharmacist tries to verify the prescription by contacting the prescriber using the phone number listed on the prescription, the forger's accomplice will pick up on the other end and pretend to be the physician.
● Recommended Resources
Literature:
Dictionary of Commonly Accepted Medical Abbreviations (any)
Physician's Desk Reference (lists prescriptive medications by trade/generic name with their classification of use, usual dosage, and forms supplied.)
State Administrative Code governing Prescriptive Procedures and Documents
Online:
List of Controlled Substances Schedule (U.S. Dep't. of Justice)
http://www.deadiversion.usdoj.gov/schedules/alpha/alphabetical.htm
A Pharmacist's Guide to Prescription Fraud (U.S. Dep't. of Justice)
http://www.deadiversion.usdoj.gov/pubs/brochures/pharmguide.htm#char Other Articles Index
Prescriptions Part 1
Prescriptions Part III
Want more information about Document Examination, call the author
Diana King : Tel: 785-309-0997 Fax: 785-309-0935 .
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