Protect the Most Vulnerable From Rx Abuse

May 30, 2013
Express Scripts recently identified a case where a 7-month old child apparently had 9 prescriptions for high doses of narcotic pain medication.
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  • Children

As a member of the Fraud, Waste & Abuse Services team at Express Scripts, I am on the front lines of fighting prescription-drug fraud and abuse. After years of working on cases, sometimes they meld together. But then there are the ones that stand out. For me, those are the cases that involve the most innocent and vulnerable among us: children.

How Abuse Impacts Children

Usually these cases have a common theme – an adult in the family is addicted to the medication. More than 22,000 people died in 2010 due to prescription-drug overdoses – one every 24 minutes. Many of these deaths result in children being left behind. Even if the improper use or abuse of medications does not result in death, there may be legal consequences, or the person involved requires long-term treatment resulting in separation from the family.

Long-Term Consequences

Sometimes children are more direct victims of crimes associated with prescription-drug abuse. We have seen cases of adults stealing or using a child’s medical ID to obtain prescription medications to feed an addiction. Kids can’t defend themselves against medical ID theft. If the case remains undetected, the potential red flag may remain on the child’s record into adulthood. The worst part about cases like these is that the child is often victimized by a parent, the one person they should be able to trust more than any other.

A Proactive Approach

Our proactive data analytics can identify such cases. We look for instances where very young children — under five years old — have prescriptions billed to them for tablets or capsules of high-strength prescription narcotics. These medications are too large for young children to swallow and their high potency would result in severe side effects.

In a majority of cases, this tends to be a data entry error at the pharmacy that can be easily corrected. But that’s not always the case.

When a Child Is the Victim

We recently identified a case where a 7-month old child apparently had nine prescriptions for high doses of narcotic pain medication. The prescriptions were obtained from nine different physicians and four different pharmacies. That ruled out a data entry error.

Eight of the prescribers were emergency room physicians – a pattern highly indicative of drug seeking behavior. The ninth was an OB/GYN. Our investigation revealed prescriptions supposedly written by the same OB/GYN for a male as well, an unusual occurrence. When the investigator contacted the doctor, the doctor stated that she wouldn’t write such high-strength narcotic prescriptions for anyone, let alone a child.

We were eventually able to identify that the doctor’s prescription pad had been stolen and that the mother of the child had been using the child’s identity to illegally obtain prescription drugs – either for her own use or to divert for financial reasons. Once we discovered the case, we reversed the claims, therefore correcting the child’s profile and helping to prevent lasting damage to his medical record. The case is also being investigated by law enforcement.

A Personal Mission

The good news is that these cases are uncommon. The bad news is that they happen at all. Identifying and resolving cases where someone – especially a parent – is taking advantage of a child, is one of my top priorities. Helping to investigate cases like this is why I love my job, and I wake up every day committed to doing everything I can to ensure that no more children are victimized.

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