The World Health Organization (WHO) estimates that up to 30% of medication on the market in developing countries in Africa are counterfeit and have found that nearly 50% of the drugs sold in Angola, Burundi, and the Congo are of poor quality. Furthermore, nearly two-thirds of anti-malaria drugs in Laos, Myanmar, Cambodia, and Vietnam contain insufficient active ingredients.

A 2003 Interpol survey on the quality of drugs available in Lagos, sub-Saharan Africa’s most populous city concluded that 80% of the drugs available were fakes. In 2008, more than 80 children in Nigeria died after being given medicine that looked, smelled, and tasted like the real thing, but was laced with antifreeze.

Why are the numbers so high? Jacqueline Sawyer, Liaison Officer at WHO’s Prequalification of Medicines Programme, told MediaGlobal “The problem of counterfeit medicines is more prevalent in countries where medicine regulation is ineffective, smuggling of medicines is rampant, secret manufacturing exists, sanctions are absent or very weak, and there is high corruption.”

Do not think counterfeit or tampered drugs only exist in developing countries. An estimated 1% of all medicines dispensed in developed countries are counterfeit. Medicines containing boric acid and other lethal substances have been found recently in certain medications.

To be sure that your drug is safe to use, check the FDA’s website. They announce drugs that might have been tampered with and also have correct packaging and dosage information.
Recent FDA Headlines:
FDA Warns About Fraudulent Tamiflu
Warning: Counterfeit Alli
FDA Issues Warning on Counterfeit Surgical Mesh

Full article here.
FDA here.

The answer is surprisingly simply ­ it hits your wallet first. Insurance premiums are increasing at a staggering rate ­ 33% in the last five years. If this continues, most individuals will not be able to afford any type of insurance, costing taxpayers even more because they will be the ones footing the bill for the uninsured.

Insurance premium increases hit the employer even harder. Many times employers (especially small businesses) are forced to reduce their workforce to accommodate the rising costs or even cut healthcare benefits entirely.

Prescription drugs are an area that is greatly affected by fraud. Fraudsters are fans of selling counterfeit medication. Consumers ingesting this medication (many times laced with poison ­boric acid for example) can end up in the emergency room with complications costing thousands.

The recent passage of Healthcare Reform is also proving to be good news for fraudsters. Many consumers have little to no knowledge of the bill and scammers have found multiple ways to cheat the innocent out of their money.

Fraudsters prey on the fear and confusion brought about by the bill. Going door-to-door selling fake insurance, scammers advertise an “ObamaCare” plan and insisting consumers better act fast due to a “limited enrollment” period. These scams bilk consumers out of thousands of dollars and leave them without any real insurance, so if a medical emergency where to occur, they would be left footing the bill.

So, what can the consumer do to help combat healthcare fraud? First, understand exactly what you’re being charged for and always ask for clarification on any charges for services that you do not recognize. Second, know where your medical identification is and alert proper authorities when your insurance card has been stolen ­ medical identity theft crimes can leave you sorting out medical bills for the rest of your life. Finally, be a conscientious healthcare consumer. Be aware of current fraud schemes and check out the Food & Drug Administration website to ensure your medication is not on the counterfeit list.

1. Rent-a-Patient Scheme
In this scheme organizations pay for—or “rent”—individuals to go to clinics for unnecessary diagnostic tests and cursory examinations. The scary thing is that licensed physicians sometimes participate in the rent-a-patient scheme. Case and point: Robert Bourseau, 75, was sentenced to 37 months in prison and ordered to pay $4.1 million in restitution for his role in a scheme to defraud Medicare and Medi-Cal. He pleaded guilty in June to paying a recruiter to deliver homeless patients to his hospital for unnecessary medical services.

2. Pill Mill Scheme
In this scheme, separate health care individuals and entities (usually including a pharmacy) collude to generate a flood of fraudulent claims that Medicaid pays. After a prescription is filled, the beneficiary sells the medication to pill buyers on the street who then sell the drugs back to the pharmacy. Example: Rick Kloxin, pharmacist in charge of Hogan’s Pharmacy in Lyons, Kans., was found guilty in an internet pill mill scheme. Kloxin pled no contest and was found guilty of 14 misdemeanor counts of violating Kansas Pharmacy laws.

3. Drop Box Scheme
This scheme uses a private mailbox facility as the fraudulent health care entity’s address, with the entity’s “suite” number actually being its mailbox number. The fraudulent health care entity then uses the address to submit fraudulent Medicare, Medicaid, and other insurance claims and to receive insurance checks.

4. Third-Party Billing Scheme
The third-party billing scheme revolves around a third-party biller—who may or may not be part of the scheme—who prepares and remits claims to Medicare or Medicaid (electronically or by paper) for health care providers. It is possible, however, for a third-party biller to defraud Medicare, Medicaid, and others by adding claims without the providers’ knowledge and keeping the remittances or by allowing fraudulent claims to be billed to Medicare or Medicaid through its service. Example: Recently, in Miami, Ihosvany Marquez and several alleged conspirators were indicted on charges of having filed $55 million in phony Medicare claims for HIV, AIDS, cancer, pain and varicose vein treatments.

Frequent incidences of prescription drug misuse:
1. Doctor shopping – hopping from doctor to doctor in order to receive medication and deceive the doctor. Patients also go doctor shopping to find a doctor that will “address” all their prescription needs i.e. over prescribing.
2. Manually changing the dose of the prescription. Example: If the prescription is written for 25 pills, they might add a 1 in front of it to make it 125 or a 0 at the end to make it 250.
3. Medical identity theft – stealing a victim’s insurance card and obtaining prescriptions under the victim’s name.
4. Inside cooperation – stealing a doctor’s prescription pad and writing prescriptions.

This list is by no means exhaustive. It just gives you a clue to what is occurring.

What are Pharmaceutical companies doing?
1. Making pills tamperproof – meaning that if they’re crushed for a stronger, more rapid high they become ineffective.
2. Patient medication guides explaining the exact purpose of the drugs and the consequences of misuse.
3. Letters to doctors and additional physician training to end the misuse and inappropriate prescribing of painkillers.

Those last 2 strategies are debatable, but they are necessary steps that need to be taken to combat prescription drug addiction.

How can providers combat the misuse?
1. Electronic health records can help combat this problem. The physician would be able to see that the patient has seen an abnormal amount of doctors and see what the patient was prescribed – eliminating the ability for a patient to be over prescribed.
2. Stop over prescribing – simple as that.
3. Understand the warning signs of users.

Read the full article here.

Counterfeit Alli looks similar to the authentic product, however some notable differences occur with packaging.
1. Outer cardboard packaging missing a “Lot” code
2. Expiration date that includes the month, day and year – authentic Alli only includes month and year
3. Packaging in a plastic bottle that has a slightly taller and wider cap with coarser ribbing than genuine product
4. Plain foil inner safety seal under the plastic cap without any printed words – authentic Alli seal is printed with “SEALED for YOUR PROTECTION”
5. Contains larger capsules with a white powder instead of small white pellets

See FDA’s full report here including pictures.

Remember – be a conscientious consumer and watch out for counterfeit medication, it could have very adverse outcomes on your health.

Names have been changed to protect the innocent.

A scary night in the ER

“I have been watching my friend for the last 24 hours. First in the ER being monitored by a machine for his heart, oxygen and blood pressure – the alarm is turned off so it doesn’t make any noise – followed by a 6 hour wait for EMERGENCY surgery – hoping that he gets in the cue prior to the onset of internal rupture. I watched patient transport almost pull him out of the room without disconnecting the tubes from the wall – a frustrating reminder that the focus on reform is not about health.

After surgery I was watching him recover and yet again the $200 monitor has the alarm turned off. I thought to myself, ‘I wonder what would happen is there was no one in the room and he couldn’t call out for help?’

My friend received a 2mg narcotic through his IV around 6:00 pm. At 8:00 pm the nurse came back to evaluate for another .5mg of the narcotic. I watched his nurse place the injection on the table, take and enter vital signs into the bedside PC and while I was looking at my notes, the nurse left the room. I asked my friend, “Did the nurse give you anything?” He didn’t know. I looked for injection marks on his right arm – nothing. I walked out and asked the nurse, “Did you give him the injection?” The nurse’s response, “You were in the room the whole time, did you not see me give it to him?”

I took a step back – I am tired and need to turn off my fraud, waste and abuse examiner’s hat. However, I wonder on these points…

1. I believe the nurse stole the narcotic and did not give it to the patient. The next day the floor nurse let me look at the medical record. The patient received the narcotic at 8:00 pm IVP – which means the nurse would have had to ask me to move since I was sitting next to the arm with the IV.

2. The on call surgeon had to wait until the on call surgical staff finished operating on the patient’s rupture appendicitis. He was ready for surgery at 10:00 pm but could not get in until 1:00 am. So what would have happened if the bowel obstruction ruptured any time before 1:00 am? Would he have died in the ER? Been transferred to another hospital?

3. What would have happened on the snowy icy night if an auto accident had been admitted? Would he have been bumped? Did the hospital put their ER in bypass mode?

4. Now what about the ER nurse, did he take the narcotic himself? Was he feeling a little ‘happy’?

See article for more information.

With the increasingly high costs of prescription medications, many people are turning to the Internet to fill their prescriptions. Internet pharmacies are a hot bed for counterfeit drugs. However, don’t assume you’re safe if you purchase from a brick and mortar pharmacy – counterfeit drugs can make their way into the supply chain anywhere.

Counterfeit drugs are currently a $28 million industry. Don’t let yourself be a victim. Below are some tips that will help.

1. If you take a medication for a chronic condition – save the packaging from the month before and compare the bottle, packaging or the pill itself.

2. If you only receive the pill in a generic bottle compare a picture of the tablet at www.fda.gov by simply searching for the medication.

3. If you are taking a medication and it just doesn’t feel the same or is not working like it normally does, see your doctor and show the medication to your pharmacist.

4. If the medication is deemed counterfeit, save a sample until you see your doctor to make sure there will be no long term complications or side effects.