DEA Highlights Industry Role to Combat Rising Prescription Fraud

The Drug Enforcement Administration (DEA) is seeing a rise in fraudulent electronic prescribing trends for controlled substances and is calling on electronic health record companies to implement tech solutions to combat the emerging threat.

“We’re seeing an emerging trend in drug diversion, and it’s really important, and it’s really impactful, and it’s utilizing technology,” said Erin Hager, diversion investigator at DEA, during a HIMSS presentation in Las Vegas Wednesday. “This emerging trend of electronic prescription drug is causing thousands and thousands of dosage units of potentially deadly controlled substances to hit the streets.”

Since DEA’s Electronic Prescriptions for Controlled Substances rule effective in 2010, Hager said she expected additional security and identity verification controls with the electronic format would mitigate prescription fraud. Instead, electronic prescriptions have “almost become [DEA’s] worst nightmare because now what’s happening is our bad actors are harder to find.”

“Now they sit behind a computer and push a button and thousands upon thousands of prescriptions can go out within hours all over the country,” Hager added.

Bad actors have increasingly used modern technology to steal a health care provider’s identity, create an electronic health record account and fraudulently order controlled substances. The order then moves to tech companies and then to the pharmacy, what Hager calls the “last line of defense.”

“[Bad actors] can start generating controlled substance prescriptions as fast as [they] can type them up. And then, as things evolve, [they] get sophisticated enough to create some sort of bot that can make them happen every three four seconds all over the country,” Hager said.

In one instance, almost 850 prescriptions went out under a fraudulent nephrologist account over the course of 72 hours. Because “the systems don’t necessarily talk to each other,” fraudulent orders can slip through the cracks.

“It goes from the [electronic health record], through these technology companies who are super uniquely positioned to see all of the data that’s coming through all of those [EHRs] and then onto the pharmacy. So now, we have another company here who has the potential along this, shall we say, supply chain of the prescription to detect that fraud,” Hager said.

While distributors are also registered with DEA to handle controlled substances and supply the pharmacy, and are required to have suspicious ordering systems reporting built in, Hager said there needs to be more defenses to boost identity proofing and evaluate orders.

“We’re hoping those individuals and those companies can start partnering … in order to build in some sort of red flag detection system. Because I think one of the really beneficial things about doing that is there’s always this balance between [wanting] to stop the bad guys [and restricting] commerce,” Hager told GovCIO Media & Research. “We don’t necessarily have to say, if we find these red flags, we have to refuse it. What I ask is, can we pump the brakes long enough to take a quick look?”