The PDL Professional Officers continue to see incidents where forged prescriptions have been presented to the pharmacy. While the introduction of Real Time Prescription Monitoring (RTPM) has become an important tool to assist pharmacists in detecting forgeries, some forged or fraudulently obtained prescriptions may still slip through the checking process.
Forgery red flags
Forged prescription incidents often involve one or more of the following:
- The prescription may be for either Schedule 8 or Schedule 4 monitored medicines that may be subject to misuse or abuse. Multiple Pharmaceutical Benefits Scheme (PBS) pack sizes are ordered.
- The patient or prescriber are from outside the local area.
- The person presents on the weekend or after usual business hours and may advise that they are in urgent need of the medication (e.g. post-surgery, travelling overseas), which increases the pressure on the pharmacist to supply. They may also claim to be the prescriber.
- The prescription has not been recorded on the RTPM system.
- The patient, prescriber or another pharmacy has phoned ahead to check if the stock is on hand.
- The patient is overly friendly and talkative (a distraction).
- Verbal or faxed/emailed prescriptions.
- The handwriting on the prescription is inconsistent with previous prescriptions from the prescriber.
- The patient has the same surname as the prescriber.
- The prescription may be a handwritten or computer-generated prescription.
The presence or absence of these commonalities alone is not enough to definitively conclude whether a prescription is a forgery, but pharmacists should be on high alert when presented with any of these scenarios and take extra care.
PDL tips to prevent dispensing a forged script
1. Contact the prescriber
- Check the prescriber details using an independent resource. Such as Google, White Pages or check the AHPRA register regarding the principal place of practice.
- Check that the clinic’s address and phone number exist.
- Sophisticated forgeries often display false contact details. Pharmacists who have called the phone number on the script have reported speaking with a “real” receptionist and “prescriber”.
- If a prescription is seemingly valid but the prescriber is not available, consider providing a small verification supply if permitted by your state legislation.
2. Confirm the identity of the person collecting the prescription
- Prescriptions may be presented by third parties. PDL is aware of fraudulent requests for both paper-based and electronic prescriptions by third parties. When there is a risk for misuse or abuse, consider requesting some form of identification and/or consent from the named patient.
3. Check recent communications
- Notifications of recently identified forgeries are often distributed to pharmacies from the Department of Health, prescribers or other pharmacies. Ensure that these are easily accessible in the dispensary.
- Stay up to date with published lists of lost, stolen or forged prescriptions if available from your local health department, e.g. NSW- Lost, stolen or forged prescriptions, VIC- Stolen and forged prescriptions.
- Check not only the prescriber’s name on these lists but the addresses and phone numbers as well. Fake phone numbers are often re-used with different prescriber names and practice addresses and may appear multiple times on the list.
4. Check the Real Time Prescription Monitoring (RTPM) system
- To confirm the prescriber has recorded the prescription, check RTPM. This is not 100% reliable as handwritten prescriptions will not display as being prescribed. In some states and territories, the use of RTPM is not mandatory so the prescribing event may not be recorded.
- Similarly, the presence of a prescribing event on RTPM does not guarantee the prescription is legitimate. The prescriber may still need to be contacted if they are not familiar to you, or you are concerned about the validity of the script.
5. Compare handwriting
- Look back at previous prescriptions, if available, from the prescriber and compare handwriting and/or signatures.
6. Don’t be fooled by PBS Authority Approvals
- Sophisticated forgeries often have valid PBS Authority Approvals. PDL reminds pharmacists not to use the existence of a valid PBS Authority Approval as a way of verifying a prescription.
7. Be aware of phone and fax scams
- In this digital age there are very few scenarios that would warrant a prescription for a high-risk medication to be phoned through. If you are not satisfied that the caller is genuine, offer to call them back so that you can make further enquiries, such as contacting the prescriber’s usual place of practice.
- Faxed or emailed prescriptions could be sent to multiple pharmacies. Confirm that the fax or email has come directly from a prescriber and verify the prescription as per the steps above. Prescriptions emailed or faxed to a pharmacy by a patient should not be dispensed. PDL is aware of cases where a false email account has been created using the practice name as a reference, however these are often Gmail, Hotmail or Yahoo accounts and therefore unlikely to be genuine.
- Confirm your postal address and confirm the script will be sent directly to you and not handed to the patient. Have a process in place to manage faxed or emailed prescriptions and ensure any prescriptions not received within the timeframe stipulated by your state or territory legislation are reported to your health department.
8. Encourage the use of electronic prescriptions
• Electronic prescriptions are more secure than paper prescriptions. Prescribers should be encouraged to use electronic prescriptions rather than faxing or emailing.
Reporting forged prescriptions
If you have detected a forged prescription, whether it has been dispensed for the patient or not, the PDL Professional Officers recommend that pharmacists:
- Prioritise staff and other patient safety.
- Make a copy of the prescription before interacting with the individual. Retain the original prescription only if safe to do so.
- Notify the police immediately.
- Document the incident as soon as possible including date, time, description of the individual and if safe to do so, their vehicle registration. Download CCTV if available.
- Review and adhere to the legislative requirements regarding reporting obligations in your jurisdiction.
- Lodge an incident report with PDL.
NSW Pharmacists
The NSW Ministry of Health has recently published an article, ‘Reminder for Pharmacists: Requirement to verify Schedule 8 Prescriptions‘, on prescription forgeries and verification of Schedule 8 prescriptions.
Recently Pharmaceutical Services at the NSW Ministry of Health has been advised of a series of forged electronic prescriptions for Schedule 8 medicines that have been presented in pharmacies across NSW.
The forged electronic prescriptions share many characteristics with legitimate prescriptions issued by the same prescriber, however there are minor variations in the prescriber contact information that can be used to indicate the forged prescriptions.
The forged electronic prescriptions have the following prescriber details (Note – these are not the prescriber’s correct phone number or email address):
Prescriber: Dr Premjeet Singh
Address: Clifton Medical Centre, 5a Clifton Drive, PORT MACQUARIE, NSW, 2444
Prescriber No: 2058302
Prescriber email address: gmail account of name “premjeetsinghcliftonmedical”
Contact Phone: (02) 6583 2555
The Digital Health Agency is aware and investigating these prescriptions.
Electronic prescriptions with the above prescriber contact details can be assumed to be fraudulent – do not dispense. Retain the prescription and report it to Pharmaceutical Services via the notification form, the police, and the Digital Health Agency (fraud@digitalhealth.gov.au).
Paper prescriptions (including computer generated prescriptions) for a Schedule 8 medicine from Dr Premjeet Singh must be verified with the prescriber prior to dispensing – please contact Dr Singh on phone number 6584 5000 to verify the legitimacy of the prescription.
Remind staff to verify Schedule 8 prescriptions by ensuring that, in addition to meeting prescription requirements for a valid Schedule 8 medicine, you either know the patient, or prescriber or you confirm the prescription is valid with the prescriber. Do not assume the prescription is valid because it was issued electronically.
For immediate advice and incident support, call PDL on 1300 854 838 to speak to one of our Professional Officers. We are here to support our pharmacist members 24/7, Australia-wide.
