Understanding Your Local Problem
The information provided above is only a generalized description of prescription fraud. You must combine the basic facts with a more specific understanding of your local problem. Analyzing the local problem carefully will help you design a more effective response strategy.
Asking the Right Questions
The following are some critical questions you should ask in analyzing your particular problem of prescription fraud, even if the answers are not always readily available. Your answers to these and other questions will help you choose the most appropriate set of responses later on.
Victims
- Whom does prescription fraud directly victimize? Pharmacists (who are duped into dispensing drugs not legitimately prescribed)? Doctors (who unknowingly prescribe to doctor shoppers, whose prescription pads are stolen, or whose names are used for prescription call-ins or forgeries)? Insurance companies and Medicaid (who sometimes pay for fraudulent prescriptions)?
- Whom does prescription fraud indirectly affect (those who commit the fraud and are addicted, and/or their loved ones)?
Offenders
- What are the offenders’ characteristics (e.g., age, gender, profession)?
- Where do they live, go to school, or work? How do those locations correspond to fraud locations (e.g., are some pharmacies or doctor’s offices more likely targets than others)?
- What is the pattern of offending? Is the fraud intermittent or regular? Is there a regular time span between fraudulent acts (e.g., based on how long it takes to exhaust a supply of drugs)?
- What are the offenders’ motives? Are they addicted to prescription drugs? Selling the drugs on the black market? Both? (You can interview offenders to collect this information. Undercover investigations, buys, and surveillance can reveal more about their practices).
- Do offenders act alone or as part of a group?
- What are their preferred tactics?
Locations/Times
- Where does prescription fraud occur? To detect patterns, you should conduct location analyses based on the tactic used (e.g., doctor shopping patterns will spatially differ from prescription call-in patterns ). Location analyses can also help you determine which targets are most vulnerable. For example, fraud in specific areas may indicate where offenders live or work.
- At what specific locations is fraud most common? Are certain doctors or pharmacies less likely to detect and report fraud? Are certain types of pharmacies (e.g., “mom and pop” stores, versus chain stores) more susceptible to fraud?
- What specific types of prescription drugs are diverted in your community or region? It is important to note that the prescription fraud problem and types of drugs diverted can vary greatly from region to region.
- When does prescription fraud occur (i.e., when do offenders try to have prescriptions filled)? Time of day? Day of week? As with location analyses, temporal analyses should be tactic-specific. Those who phone in prescriptions, for example, are more likely to do so during doctors’ off hours, when pharmacies cannot verify the prescriptions.
Capturing and Analyzing Data
Prescription fraud poses a unique challenge to local police because it is not typically captured in computer-aided dispatch or records management systems. Departments that have succeeded in measuring and analyzing prescription fraud in their jurisdictions have done so by creating a separate database for prescription fraud and other pharmaceutical diversion incidents. When considering creating a database, your agency should examine the questions above, and decide how to track each incident to best answer the most possible questions.
Measuring Your Effectiveness
Measurement allows you to determine to what degree your efforts have succeeded, and suggests how you might modify your responses if they are not producing the intended results. You should take measures of your problem before you implement responses, to determine how serious the problem is, and after you implement them, to determine whether they have been effective. All measures should be taken in both the target area and the surrounding area. (For more detailed guidance on measuring effectiveness, see the companion guide to this series, Assessing Responses to Problems: An Introductory Guide for Police Problem-Solvers.)
The following are potentially useful measures of the effectiveness of responses to prescription fraud:
- reduced number of reported prescription fraud cases;
- changes in arrest patterns for drug possession and sales in your and neighboring jurisdictions;
- changes in types of prescription fraud (e.g., if you curtail phone-ins, offenders might change tactics);
- changes in locations of prescription fraud;
- changes in types of drugs obtained through prescription fraud; and
- reduced number of prescriptions filled for certain target drugs, such as OxyContin.
It is important to remember that some of these measures may be misleading, depending on the types of responses your department applies to the problem. For example, if you launch a public education campaign for pharmacists and doctors, you may find that the amount of prescription fraud—as measured by crimes reported to the police—increases.