Forged and fraudulent prescriptions
Regulation 51 prohibits pharmacists from supplying a Schedule 8 poison on a prescription unless the prescription is handwritten; the pharmacist is familiar with the purported prescriber's handwriting and the writing on the prescription is comparable to the usual writing of the purported prescriber or the pharmacist has taken all reasonable steps to verify that the prescription was written by the purported prescriber. Where neither of these requirements can be met, a pharmacist may supply a quantity of a Schedule 8 poison sufficient for not more than 2 days' treatment.
Note: The fact that a prescription appears to be computer-generated; has been previously dispensed at the same or another pharmacy; or is a PBS Authority Prescription does not mean it is a lawful prescription. Pharmacists must comply with the provisions of regulation 51 for all prescriptions for Schedule 8 poisons - not only those prescriptions that arouse suspicion.
Do not assume that a prescription is genuine
Forged and fraudulent computer-generated prescriptions are as prevalent as handwritten prescriptions and are often more difficult to identify; computer-generated forgeries fall into three main categories:
- Scanned copies or colour photocopies of genuine prescriptions; these prescriptions often lack the perforated edges that are evident on genuine prescriptions and can often be detected by careful examination.
- Forgeries that are printed with a PC using stolen prescription pages; on some of these forgeries, the prescriber's information on the prescription does not match the pre-printed information on the back of the prescription. Spelling errors may also be apparent upon closer examination.
- Manual alterations to the quantity or number of repeats prescribed; medical practitioners are not authorised to make manual alterations to computer-generated prescriptions; the 'Criteria for computer-generated prescriptions' can be found in the summary document, for multiple categories of health practitioner, 'Handwritten and computer-generated prescriptions'.
Strategies to address possibly forged prescriptions
1. Examine all prescriptions critically
Many offenders create fraudulent prescriptions by copying information from a genuine prescription but, when doing so, they use incorrect spelling for the name of a medicine or incorrectly copy something that they don’t understand (e.g an incorrect abbreviation for directions).
2. Comply with regulatory requirements
Regulation 51 requires pharmacists to verify prescriptions for Schedule 8 medicines if the prescriber’s handwriting is not familiar. This requirement applies to all prescriptions (including repeats) for Schedule 8 medicines; not only if a pharmacist is suspicious.
Many offenders attend pharmacies at times when it is difficult to contact prescribers or otherwise verify that a prescription is genuine. This is why the regulations allow for the provision of up to two-days’ supply of a Schedule 8 medicine if the authenticity of a prescription cannot be confirmed.
3. Record details of communications with prescribers
Recording all intervention communications ensures colleagues are aware of relevant matters. Do not assume that one of your colleagues has confirmed that a prescription is genuine unless there is evidence to support that belief.
4. Check the DPR website for forged/stolen prescriptions that have been reported
The DPR website contains frequently updated details of forged and stolen prescriptions (see ‘Stolen and forged prescription tables’ and ‘Stolen pages for computer-generated prescriptions’), which allow pharmacists to search for names of purported prescribers and for the details that are pre-printed on the rear of stolen pages for computer-generated prescriptions.
It is strongly recommended that pharmacies have these pages bookmarked or listed as a favourite site to facilitate prompt reference.
Note: The fact that a purported prescriber is not shown on the DPR website does not mean that a prescription is not fraudulent.
Ask for identification
Many offenders write fraudulent prescription using a false name. When asked to provide identification, the response or excuses offered can fuel an existing suspicion. If an appropriate form of photo identification is provided, it can serve to subsequently identify an offender.
Examples of forged prescription scams
Repeatedly successful scams often involve patients who are well known to the pharmacy. In some of the following examples, pharmacists were prosecuted for failing to comply with their legislative responsibilities:
- A genuine prescription was presented at a pharmacy where the prescriber’s handwriting was familiar and was not questioned. A forgery was presented at another pharmacy on the same day, with the prescriber confirming having issued a prescription when contacted by the pharmacy. In some cases it might be appropriate to fax a prescription to the purported prescriber for verification.
- One pharmacy dispensed more than 100 fraudulently altered computer-generated prescriptions (for morphine ampoules) from a person well known to the pharmacists; prescriptions for five ampoules were fraudulently altered to quantities varying from 25 to 75 ampoules. It is not lawful for a prescriber to manually alter a computer-generated prescription.
- A pharmacist dispensed a forged computer-generated prescription that identified the medication as ‘dextroamphetamine’. Dispensing software does not usually spell the name of a medicine incorrectly.
- An offender obtained more than 50 dexamphetamine tablets per day by photocopying repeat authorisation forms and attaching the copies to the original prescription. After 25 repeats had been dispensed on a prescription with only 5 repeats authorised, critical observation identified that there was an excessive number of staple holes in the duplicate prescription and that many dispensing stickers had been removed.
- A man obtained more than 800 injections for anabolic steroids in a 3-month period, by presenting forged prescriptions at more than 30 pharmacies. The unusually large quantity was supposedly for an overseas trip.
Pharmacists have been prosecuted
Too many pharmacists have dispensed forged or fraudulently altered prescriptions (sometimes on multiple occasions) in circumstances where, had they fulfilled a number of their legislative responsibilities; examined the prescription critically; and/or examined the DPR website list of stolen prescriptions; the fraudulent prescriptions would have been identified.
Pharmacists might find it difficult to justify having dispensed forged prescriptions if they:
- fail to contact prescribers in circumstances where regulations 51 and/or 70 are applicable
- fail to contact prescribers where they might otherwise be expected to do so (e.g. excessive prescribing)
- fail to contact DPR where section 36 of the Act is applicable (see "Excessive supply" below)
- rely upon the fact that the handwriting on one forged prescription is consistent with that of an earlier prescription, which was also a forged prescription
- fail to discover that a purported prescriber's details had already been added to the list of stolen prescriptions on the frequently updated DPR website.
Fraudulent prescriptions to be reported to DPR and police
Pharmacists must notify the police and DPR when they suspect or have reason to believe that a person has obtained or attempted to obtain Schedule 4 and Schedule 8 poisons by means of a false pretence (regulation 69). The presentation of forged or fraudulent prescriptions (whether or not the drugs were supplied) should be reported to DPR by completing and submitting the corresponding form (to be found in the section for Commonly used online forms).
A pharmacist was recently prosecuted for failing to report forged and fraudulently altered prescriptions to DPR after discovering that he had dispensed numerous forgeries.