'Doctor shopping' is a 'daily problem'By PAUL FEELY
New Hampshire Union Leader
July 13. 2013 11:08PM
The arrests of several people last month on charges related to "doctor shopping" in Rockingham and Hillsborough counties have put a spotlight on the crime.
"Cases like that are just the tip of what's going on," said Trooper Marc Beaudoin, the Drug Diversion Investigator with the Narcotics and Investigations Unit of the New Hampshire State Police. "We are busy every week with cases like those, but they are only the most egregious cases. The amount of fraud every year in this state is easily into the millions of dollars."
"Doctor shopping'' is a term applied to people who go from one doctor to another in an effort to obtain prescription drugs for illegitimate use.
The Coalition Against Insurance Fraud, an alliance of consumer groups, insurance companies and government agencies, put the cost of prescription painkiller abuse for insurers at up to $72.5 billion in a 2007 study, the last report it compiled on the topic.
The study claims the average "doctor shopper" costs insurers $10,000 to $15,000 a year because fraudulent use of the medication can drive up the costs for legitimate patients.
"Everyone knows that doctor shopping is a problem," said Dr. Gilbert Fanciullo, director of the Pain Management Center at Dartmouth-Hitchcock Medical Center in Lebanon. "Doctors want to be able to help, they want to prescribe appropriate pain medications to treat conditions. But they also have to worry about who is addicted to the drug, who is diverting the drug, and who is abusing the drug."
According to Dr. James Martin, director of the emergency and EMS departments at St. Joseph Hospital in Nashua, the driving force behind the phenomenon is addiction.
"It's a daily problem," said Martin. "It impacts our ability to provide care to other patients."
Fanciullo said the time a physician spends trying to determine whether someone is looking to get their fix or legitimately in pain translates into longer wait times for others. He said doctors at his center ask a series of questions of anyone they treat in an attempt to determine whether they are lying about their condition.
He concedes the process is far from foolproof.
"You ask the questions, but they aren't going to stop everyone," said Fanciullo. "With so many addicts looking for prescription pills, it makes doctors hesitant to prescribe certain drugs. That lowers a person's chances of getting the pain relievers they legitimately should be getting."
Numbers on rise
Statistics on prescription drug abuse show the extent of the problem in the state.In the latest Youth Risk Behavior Survey, conducted in 2011, one in five high school students said they had taken prescription drugs - such as Oxycodone, Xanax or Adderall - without a prescription.
According to data provided by the New Hampshire Department of Justice, prescription drug overdoses rose from 40 in 1999 to 163 in 2007. The number climbed to 164 in 2009 (in 83 of those cases, the drug was lawfully prescribed, compared with 63 where it was illicitly obtained).
By comparison, there were 14 homicide deaths and 115 traffic deaths that year.
In the State Police Narcotics Unit, Beaudoin and civilian investigator Christopher Shambarger, a licensed pharmacist, investigate cases of doctor shopping and prescription fraud.
"It's really us against New Hampshire," said Beaudoin.
Beaudoin said many culprits photocopy their prescriptions, then visit multiple pharmacies. Others make their own prescriptions - some using computer programs, others going so far as to purchase special security paper over the Internet, mimicking what doctors use.
If Beaudoin and Shambarger feel an investigation has yielded enough evidence of prescription fraud, they charge the person under RSA 318-B:2, Section XII-a, which targets a person who "knowingly acquired or attempted to acquire possession of a controlled drug by misrepresentation, in that the person consulted with two or more physicians for the same ailment solely for the purpose of obtaining additional quantities of the controlled drug, which he/she would not otherwise have legally obtained from one physician."
Doctor shopping is a Class B felony in New Hampshire and carries a sentence of 3½ to seven years in prison and up to a $4,000 fine.
Beaudoin described a scam his unit helped stop in the Londonderry area. He said a woman, identified as Jodie Holmes, 40, of Londonderry had created prescriptions on her computer and, with the help of others, had them filled at pharmacies. One pharmacist got suspicious and contacted the Board of Pharmacy, Beaudoin said.
"Several other very similar fraudulent prescriptions were being found all over southern New Hampshire and northern Massachusetts," said Beaudoin.
He said the scheme took place in September 2010, with arrests made in December 2010 and January 2011.
"We identified approximately 20 other individuals that were assisting her in obtaining controlled drugs. The prescriptions were usually paid for in cash, but in some cases insurances were used."
Beaudoin said the prescriptions were always for 180 30-milligram tablets of Roxicodone, a form of oxycodone. Tablets were sold for $20 to $30 apiece, according to Beaudoin.
Sometimes health care professionals themselves are charged.
On July 3, the state Board of Nursing suspended the nursing licenses of Alexandra Hunt, RN, of Center Sandwich, following allegations that she falsified approximately 65 prescriptions between October 2011 and June 2013. Investigators with the Attorney General's office allege she would write the prescriptions for Oxycodone, Zolpidem and Alprazolam for a person who was not currently a patient of hers, then pick up the prescriptions for her own use.
The board suspended her nursing license in New Hampshire, and a hearing regarding the allegations has been scheduled for July 18 to determine if it will remain suspended while authorities continue their investigation.
New program delayed
In 2012, New Hampshire passed a law to allow a program to be set up to monitor opiate prescription drugs through a state database, which Beaudoin and Fanciullo say will allow doctors and pharmacists to see whether a patient has been prescription shopping.
The state's Board of Pharmacy was charged with launching the program, but that has proved more difficult than anticipated, according to board Executive Director Jay Queenan. The program won't be ready until June 2014 at the earliest.
"I think that's a realistic timetable," said Queenan. "We should receive the grant money for the program in October, and once we have it we can begin the RFP (Request for Proposals) process."
Under the legislation, collected information - including a patient's name and address, the type of drug and quantity dispensed, whether the prescription was a new request or a refill, and the prescribing physician - must be deleted after six months, but can be maintained for up to three years if officials feel the data suggest an individual has been doctor shopping. No state funds will be used to establish or administer the program; it will be funded by gifts, grants or user contributions.
"It will put a huge dent in the practice of doctor shopping and prescription fraud," said Beaudoin.