How to respond to precription theft?
October 29, 2010 11:01 AM   Subscribe

Stolen prescription meds (I assume). Drugstore manager is unconcerned, or he's in on it. What should I do?

On the 14th of August I started a rx at a regular branch of a major drugstore chain (never having had any relationship with the branch before then) and picked up my first bottle.

This drug runs $700+ a bottle. I can't imagine it's a potential street drug; it's a maintenance drug with no desirable effects except for someone who has my (rare) chronic disease.

The bottle was marked 4/day, but for now, unless my symptoms are very bad I'm supposed to take only 2/day. Therefore, although the bottle is 120 pills, it took me about two months to call and say I wanted to pick up my second bottle.

The pharmacy employee on the phone told me I had picked up the second bottle on the 28th of September. Not only did I not pick it up then (or ever), I was out of state on the 28th (and if it came to an investigation I assume this could be proven, because I was both using my cell phone and connecting to the internet from the other state). I told her this and she just kept insisting her records stated I'd come and signed for it on the 28th. She said (falsely, as I later found out) that her branch keeps no security camera footage for more than two weeks, so there couldn't be any footage of that day.

After many requests, I finally got her to transfer me to a manager. He said he'd investigate and called me back an hour later. He was strangely casual, saying he doesn't "really understand everything that goes on in the Pharmacy" and "no one is claiming" I'd actually come there on the 28th -- but the bottle was gone and recorded as having been sold on the 28th, and my insurance had been billed for it. He said they would just get another bottle ready for me under the table, not billing it to my insurance.

When I came in the next day, they did give me this 'unofficial' bottle. They didn't charge me the copay (which is supposed to be $3); the barcode for it was crossed out with pen lines. There was a note on the bag with underlines for emphasis: "Make sure customer signs log book _PLEASE_" (which sounds to me like someone trying to further imply I'd picked up a bottle in September and somehow not signed for it).

Obviously all of this is extremely suspicious. My best guess is that some employee noticed an apparently-abandoned rx with a high value, decided to take the risk of faking a pickup, and pocketed the bottle. Manager could be unconcerned, or he could be in on this himself, or possibly he could be doing something about it but decided to play dumb on the phone (because he didn't want to reveal any more to somebody outside the company). Or employee could've handed me to a coworker who pretended to be a manager.

Future actions: I cannot transfer my rx away from this branch, because I have Medicaid (which globally prohibits rx transfers in my state, even to another branch of the same drugstore), but I could cancel it if I got a new one first. What else should I think about doing? Do I need to notify Medicaid in some way to protect myself in the future, talk to someone at the branch who I'm sure is actually a manager, and/or do anything else? Should I write a letter with all this information and send it to a corporate address at the drugstore chain?

This is my first prescription in many years, and my first year with health insurance in many years. I'm feeling very lost and getting very concerned about something being messed up in the future.
posted by anonymous to Health & Fitness (14 answers total)
 
My best guess is...

You're not a detective, so please do not try to play the detective. For all you know, someone overheard when your medication was going to be ready and pretended like he was going to pick it up for you. I've had plenty of people pick up medication for me before, and they get them, no questions asked.

They screwed up and corrected it. They got their money, you got your pills. Someone else is out there with some drugs they can't but thought they could. If you're worried, write a letter. If you're really worried and have the time and energy, go through the steps to get your stuff transferred.

Otherwise, I'd shy away from conspiracy theories. They get you nowhere and only make you sound like a loon when you try to present them to someone with authority.
posted by griphus at 11:07 AM on October 29, 2010 [1 favorite]


Contact your Medicaid office and see about getting your prescription moved, reissued, whatever. You're having a customer service problem and are under no obligation to put up with that crap.
posted by valkyryn at 11:08 AM on October 29, 2010 [4 favorites]


I agree with calling the Medicaid office and explaining the situation. No one should put up with this crap-for-customer service.
posted by 6:1 at 11:17 AM on October 29, 2010


If the drug company didn't try to bill your insurance for the 3rd bottle of bills you really have nothing to worry about. It's not your job to run the pharmacy. The most dramatic thing you might consider doing is transferring your prescription to another pharmacy.
posted by COD at 11:18 AM on October 29, 2010 [1 favorite]


In my state, there is a pharmacy board that is responsible for regulating pharmacies and they welcome consumer input. I'm not sure if it means anything happens when you complain about things [I have a local pharmacy that seems to often be out of common prescription medication which is a serious inconvenience for me and I've written them a few times] but they would probably be good people to get ahold of. I agree that you're not sure what happened and it's not at all clear to me that they didn't just try to hack their system to provide decent service after whatever mystery thing happened. So, I'd try to stick to the facts, write a letter and leave it at that.
posted by jessamyn at 11:18 AM on October 29, 2010 [2 favorites]


Agreeing with the others that you should approach complaints about this in a "this is terrible customer service" fashion rather than a "someone stole my drugs" fashion. I would complain (perhaps in person?) to the head pharmacist at your drug store and the store manager. And I would also report it to Medicaid and petition to have them move your prescription to another location.
posted by phunniemee at 11:20 AM on October 29, 2010


Do I need to notify Medicaid in some way to protect myself in the future

Yes. In the future and for this specific instance. If you don't trust the pharmacy to keep good records, you can't really trust them to fix this problem.
posted by rhapsodie at 11:56 AM on October 29, 2010 [1 favorite]


I would report this to whoever will hear me. A million things could go wrong. What's your guarentee that they are giving you the right drugs now? how will you be able to complain if they turn out to be something different/spoiled/less than they should be? You need to complain about customer service AND suspicious activity.

that they "fixed" the issue (if indeed they did, instead of planting the problem onto you) is good, but irrelevant. with issues like this, if something irregular happens, it must be documented. I hardly believe this is the end of the story. they now have to account for two bottles of very expensive medicine when only one got paid. somebody will be blamed for this, and you need to cover your butt.

report report report!
posted by Tarumba at 12:06 PM on October 29, 2010 [1 favorite]


I would definitely report this to Medicaid. It sounds suspiciously enough like Medicaid fraud (which is a MASSIVE problem) to be credible. And I would not want to risk Medicaid finding out about it somehow down the line and dropping you from their coverage in punishment.

If it were me, my worry would be that, by accepting these clearly unmarked/unpaid-for pills, along with their explanation that they had already billed Medicaid for it by mistake, that I would be considered complicit to the crime. I don't know what the legalities actually are; I just know that I wouldn't want to get caught up in them.

If you register a complaint with Medicaid, then it's on file with them. And if something happens down the road, you can point to the notation in your file and say, "I complained about this, I didn't participate in it."

Long story short: my inclination, as always, is to CYA.
posted by ErikaB at 12:49 PM on October 29, 2010 [2 favorites]


Coming from a family of pharmacists, I will say that sometimes things get screwed up and in the name of customer service (and the health of the patient) you hand off some meds to the patient without it being billed.

The simplest explanation is this: They filled the script. They lost the script (say, took it out of the bin on the 28th because you didn't pick it up but marked that down incorrectly). They gave you some new pills to make up for it. Even if an employee stole it, that isn't your problem; if the drugstore thinks someone is stealing from the pharmacy, they will come down hard on it. They also are not going to tell you they think an employee is stealing, it's terrible PR.

I think that Medicare fraud at a large chain drugstore is highly unlikely. The pharmacists aren't getting paid on a commission basis or anything, they have no reason to do anything wrong. The manager you spoke to was probably the store manager, who in all my experience knows exactly nothing about the pharmacy portion of the store. They're regular joes who work their way up from cashiers and aren't usually very canny.

If there's a pattern of disappearing drugs at the store, they'll take care of it on their own. You really don't need to be concerned about this.
posted by soma lkzx at 1:00 PM on October 29, 2010 [4 favorites]


I wonder if the answerers pooh poohing your concerns about fraud have given due attention to your account of the timing of all this:

On the 14th of August I started a rx at a regular branch of a major drugstore chain (never having had any relationship with the branch before then) and picked up my first bottle.

This drug runs $700+ a bottle. I can't imagine it's a potential street drug; it's a maintenance drug with no desirable effects except for someone who has my (rare) chronic disease.

The bottle was marked 4/day, but for now, unless my symptoms are very bad I'm supposed to take only 2/day. Therefore, although the bottle is 120 pills, it took me about two months to call and say I wanted to pick up my second bottle.

The pharmacy employee on the phone told me I had picked up the second bottle on the 28th of September. Not only did I not pick it up then (or ever), I was out of state on the 28th (and if it came to an investigation I assume this could be proven, because I was both using my cell phone and connecting to the internet from the other state). I told her this and she just kept insisting her records stated I'd come and signed for it on the 28th. She said (falsely, as I later found out) that her branch keeps no security camera footage for more than two weeks, so there couldn't be any footage of that day.


In other words, if you took these pills at exactly the rate that was stated on the label of your prescription, the label only the pharmacists would have had access to, you would have needed a new bottle around September 14.

On September 28th, according to pharmacy records, you picked up a second bottle of these pills-- except that you didn't.

The fraud scenario is that the pharmacy, after waiting two weeks to be reasonably certain you weren't going to renew (necessary because it would look suspicious if there was a pattern of people coming in to renew their prescriptions a few days late and finding the pharmacy claiming they already did) claims that you actually did and bills Medicare for it.

I think such timing makes this much less likely to be a simple mistake.

If it is fraud, it generates money by adding an extra bill to a given prescription which has renewals left that the patient does not actually use.

That must end up being a fairly high proportion of prescriptions of people on Medicare, I'd think, but would seem only to be profitable enough to justify the risk if practiced on a large scale, or over a long period of time.

I think you have discovered a potentially significant fraud in full operation.

Here is a page describing step-by-step procedures for reporting such fraud.
posted by jamjam at 1:12 PM on October 29, 2010 [3 favorites]


You can also report here.
posted by stormpooper at 2:03 PM on October 29, 2010


I work in a Pharmacy and this is Occam's Razor fodder for us folks, I think there is a pretty simple and plausible explanation for this situation. It's just going to take a bit of explaining:

-You fill a maintenance medication at Big Chain Pharmacy. Because it is assumed that you will be on this medication indefinitely, and the pharmacy was not notified of any change in dosage/frequency, they put it on automatic refill. Why? Because if it costs $700 a month and it's for a rare chronic disease, there's very little chance they keep it in
stock and only special order it for, at most, one or two patients a month. Automatic refill means they can actually have it ready if you, say, call to request a refill at 6pm on a Friday night after you've run out (sadly, this happens all the time).

-After a month, the medication is ordered and filled. Most chain pharmacies are pretty vigilant about weeding the scripts that haven't been picked up out the bins on a 2-3 week basis, at which point the medication is SUPPOSED TO BE reversed off of your insurance and the medication is returned to stock. Depending on the volume of prescriptions they fill each month, there could easily be 50-100 that need to be reversed and returned to stock. This can be a pretty lengthy process that doesn't get done in one shot (or even one day). If one fell through cracks at the reversal stage of the process, but was returned to
to stock, it could easily look like the medication had simply been picked up and not signed for (especially if they're still using an actual LOG and not electronic signatures).


-Pharmacy employee transfers you to store manager. Store manager tells Pharmacist in charge, the matter is looked into and, lo and behold! it was returned to stock but not reversed. They reprint the label from your last fill, slap it on the bottle that wasn't picked up, and don't charge you the copay. No re-billing to medicaid. No lost refills.


The easiest way to tell if this happened? Look at three things: the date on the label you just picked up, the refills on your first bottle, and the refills on this one. If the date on the recent refill is on or around the 14th of September and the number of refills on the second label is one less than the first, the above happened. If the date is different but the refills have only gone down by one, the above happened, but they reversed the first claim and resubmitted it on a later date.

Whew! Sorry for the novel, and I sincerely apologize if the tone came across in the least bit snarky.
posted by metricfuture at 4:30 PM on October 29, 2010 [6 favorites]


No one should put up with this crap-for-customer service

You may have better luck with Medicaid (everyone's right on insisting on the transfer) by framing it as fraud, which it is. Customer service? *shrug*
posted by whatzit at 3:41 AM on October 30, 2010


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