Doctor Shopping: How It Works and Why It’s Illegal

Doctor Shopping: How It Works and Why It’s Illegal

Doctor shopping is when someone sees multiple doctors to get multiple prescriptions for controlled substances. It’s a big problem today, especially with the opioid crisis. Let’s take a closer look at how doctor shopping works and why it’s illegal.

What is Doctor Shopping?

Doctor shopping is when a patient visits multiple doctors to obtain controlled prescription drugs illicitly^[1]. They might see different doctors during one illness episode, or over time to stockpile medications. The main goal is getting multiple prescriptions for drugs like opioids, stimulants, or sedatives that can be abused or sold illegally.

Some warning signs of doctor shopping include^[2]:

• Seeing doctors at multiple clinics, often far apart
• Paying cash and refusing insurance billing
• Resisting alternate treatments or lower dose prescriptions
• Focusing on one drug over others
• Exaggerating or lying about medical history

Doctor shoppers might claim to have severe pain, anxiety, insomnia or other hard-to-verify symptoms. They research symptoms and treatments to sound convincing. Some even forge medical records or prescription pads. Their goal is maximizing access to addictive medications.

Why Do People Doctor Shop?

There are a few main motivations behind doctor shopping^[3]:

• Addiction – To feed an addiction to prescription medications
• Diversion – To sell medications on the illegal market
• Profit – Some people doctor shop just for the money
• Munchausen Syndrome – A mental illness involving fabricated illnesses

Addiction is the biggest driver of doctor shopping. People dependent on opioids, sedatives, stimulants or other drugs need constant access. Visiting multiple doctors ensures they get the prescriptions they need. Even if one doctor cuts them off, they have several more.

Selling diverted prescriptions illegally is also a major motivation. Prescription opioids can sell for high prices on the street. Doctor shoppers can make thousands supplying people with addictions. Some doctor shop simply for profit, without using the medications themselves.

In rare cases, doctor shopping is linked to Munchausen Syndrome^[4]. This is a mental illness where people pretend to be sick to gain sympathy and attention. Doctor shopping allows them to undergo unnecessary tests and treatments.

How Do People Doctor Shop?

Doctor shoppers use various tactics to get the prescriptions they want^[5]:

• Visiting walk-in clinics where they won’t be recognized
• Finding doctors in different health systems and cities
• Paying cash to avoid insurance red flags
• Withholding info about other doctors and medications
• Lying about medical history and drug abuse
• Exaggerating pain levels or other symptoms
• Aggressively demanding certain medications
• Forging medical records or prescription pads

The key is visiting doctors who don’t know the patient’s history. Doctor shoppers target busy clinics and emergency rooms where there’s less time to verify records. They avoid insurance claims which could reveal prescriptions from other doctors. They lie about their symptoms and medical history.

Some common lies include:

• “I’m allergic to everything but this one medication.”
• “I lost my medication and need an emergency refill.”
• “My pain is a 10 out of 10, nothing else works.”
• “This is the only medication that works for me.”

Doctor shoppers know which medications to ask for and what symptoms to fake. They’ll firmly reject alternatives or lower doses. Some even forge medical records and prescription pads to bolster their claims.

Why is Doctor Shopping Illegal?

Doctor shopping is illegal for a few key reasons:

• It contributes to prescription drug abuse and diversion.
• It puts the patient’s health at risk.
• It wastes doctors’ time and healthcare resources.
• It contributes to fraud and raises insurance costs.

The main issue is diversion and abuse of controlled substances. This includes opioids, stimulants, sedatives and other addictive medications. Doctor shopping is a pipeline supplying medications that fuel the opioid epidemic and other substance abuse.

Taking high doses of multiple medications also endangers patients’ health. It increases overdose risk and long-term side effects. Doctor shoppers seeking drugs overlook real health issues.

From a medical perspective, doctor shopping wastes time and resources. Doctors can’t provide proper care without knowing patients’ full history. It leads to redundant tests, incorrect diagnoses and unsafe drug combinations.

On the financial side, doctor shopping strains insurers. Fraudulent claims raise costs for everyone. That’s why insurers monitor claims for red flags like prescriptions from multiple doctors.

Legal Consequences of Doctor Shopping

Doctor shopping is illegal under federal and state laws. Charges often include:

• Obtaining a controlled substance by fraud or deceit
• Prescription forgery
• Identity theft
• Healthcare fraud
• Insurance fraud

Punishments vary based on the charges and jurisdictions. Federal charges under the Controlled Substances Act can include fines up to $250,000 and prison up to four years. States laws add other penalties like license revocation.

Civil consequences may include:

• Loss of prescribing privileges
• Loss of medical license
• Terminated controlled substance registration
• Exclusion from Medicare/Medicaid

Doctors who prescribe inappropriately may face discipline too. Penalties target their medical license, DEA registration and hospital privileges.

How to Prevent Doctor Shopping

Stopping doctor shopping requires efforts by lawmakers, doctors and the healthcare system. Some key strategies include:

• Prescription drug monitoring programs (PDMPs)
• E-prescribing and centralized databases
• Patient-provider agreements and pill counts
• Limiting ED opioid prescribing
• Mandatory use of PDMPs by providers

PDMPs are state databases tracking controlled substance prescriptions. They help identify patients seeing multiple providers for medications. But only querying PDMPs when concerned is not enough. Making their use mandatory improves detection of doctor shopping.

E-prescribing also reduces doctor shopping versus paper scripts. It prevents patients from altering or duplicating prescriptions. Centralized databases stop patients from filling scripts at multiple pharmacies.

Agreements between patients and doctors build accountability. They outline pill count monitoring and other measures to ensure appropriate use. Limiting opioid prescribing from emergency departments disrupts a common doctor shopping channel.

On an individual level, doctors can help by:

• Running PDMP reports on all patients
• Requiring patient identification and proof of residence
• Calling other providers listed to confirm history
• Avoiding early refills without verification
• Watching for cash payment, resistance to lower doses, and other red flags

While doctor shopping is difficult to stop completely, various stakeholders can help reduce it. Cutting off easy access to addictive medications saves lives and protects public health. It also ensures responsible pain management for patients who truly need it.

The Bottom Line

Doctor shopping contributes to prescription diversion, drug abuse and poor medical care. It exploits doctors trying to help patients in good faith. While rare cases involve mental illness, most doctor shopping centers on addiction and profit.

Stopping this unethical and illegal practice requires coordinated efforts. Prescription monitoring, e-prescribing, patient agreements and database checks help. But at the end of the day, providers must remain vigilant. Ensuring medications go to patients with legitimate needs is an important way doctors can fight the opioid epidemic.

References

[1] NCBI. Doctor Shopping. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3552465/

[2] NCBI. Health Information Technology and Doctor Shopping: A Systematic Review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551569/

[3] CDC. Doctor Shopping Laws. https://www.cdc.gov/phlp/docs/menu-shoppinglaws.pdf

[4] FindLaw. Doctor Shopping Laws. https://www.findlaw.com/healthcare/patient-rights/doctor-shopping-laws.html

[5] ScienceDirect. What Prescribers Can Learn From Doctor Shoppers. https://www.sciencedirect.com/science/article/pii/S155541551300665X

NCBI. Doctor Shopping. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3552465/

CDC. Doctor Shopping Laws. https://www.cdc.gov/phlp/docs/menu-shoppinglaws.pdf

FindLaw. Doctor Shopping Laws. https://www.findlaw.com/healthcare/patient-rights/doctor-shopping-laws.html

NCBI. Health Information Technology and Doctor Shopping: A Systematic Review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551569/

ScienceDirect. What Prescribers Can Learn From Doctor Shoppers. https://www.sciencedirect.com/science/article/pii/S155541551300665X