“Prescription Fraud” as it is commonly known, is obtaining controlled substances (illegal drugs) in a fraudulent manner by the use of a doctor’s prescription. Prescription fraud cases can be prosecuted in state or federal court depending on the complexity of the underlying activities, yet most of these cases are prosecuted in state court as a charge of obtaining controlled substances by fraud or a similar charge.

More complex fraudulent prescription fraud cases, such as a continual scheme to obtain controlled substances, or large volumes in numbers of prescriptions used, could result in a conspiracy charge or fraud scheme charged in federal court. These federal cases are to be distinguished from large numbers or unnecessary prescriptions given by a physician, known as “pill mill” cases. A pill mill is the name given to a physician’s office or clinic wherein doctors and other health care workers are accused of providing prescriptions for pain medications where there is no medical necessity.

Typical Prescription Fraud

The more-common prescription fraud case involves an individual who obtains controlled substances without a legitimate prescription, or the individual obtains more controlled substances than his/her prescription allows.

Another common variation of these prescription fraud cases includes obtaining prescriptions that, by themselves, would be legitimate; however, the patient obtaining the prescriptions is seeing several or numerous doctors, obtaining numerous prescriptions for the same, or same type of, substance without telling all the other doctors that he/she is seeing numerous doctors at the same time. Thus, the patient obtains numerous prescriptions that are issued by a physician, and the patient can obtain a lot more substances to feed his/her addiction, to create a high, or to sell the excess controlled substances. Often, the substances here are pain medication.

Types of Fraudulent Prescriptions

  • Altered prescriptions, that is, legitimate prescriptions with altered (increased) amounts of the substance to obtain additional amounts of legitimately prescribed drugs.
  • Stolen prescription forms from physicians’ offices that are written for fictitious patients.
  • Prescriptions to the real individual with forged doctor’s names.
  • Legitimate prescription forms from a physician with a different callback number where a co-conspirator “verifies” the prescription.
  • Calling in own prescriptions with their telephone number for a callback confirmation.
  • Computer-generated prescriptions for fictitious physicians.

Indictments

Indictments charging criminal cases of prescription fraud are commonly prosecuted in state court as referenced above, and more complex schemes can be prosecuted in federal court.

The federal cases are charged as a violation of Title 21 of the United States Code, and state prosecutions are accomplished by a charge of Obtaining Controlled Substances by Fraud, or a similar charge. In state court in Texas, the statutes used for this prescription fraud are found in the Texas Health and Safety Code, §489.129.