The biggest thing we covered was prescription fraud. People stealing or forging doctor's prescriptions. Some were more subtle about it. Sometimes you'd see a patient filling a 30mg Oxycodone, 90 count.
Leads would come from either the Doctor, or the pharmacy. 30mg Oxycodone/90 is generally a "You are in massive pain and probably dying" prescription. So when a health 20 something year old walks in and has it filled for themself, it raises some eyebrows. They'd either call the Doctor to verify, who'd call us to investigate, or theyd call us and then we'd call the doctor.
But the state already has access to this information. All prescriptions are logged in the Prescription Monitoring Program, which I believe all states how now. Any Doctor can get a spreadsheet of all prescriptions filled in their name over the last N days, who it was prescribed to, what for, and when. It was an invaluable tool. Doctor Adams tells us he never wrote this prescription for Bill. We lookup Bill and see he has filled similar suspicious prescriptions from Doctor Charles and Doctor Daniels. We talk to Charles and Daniels and they tell us that Bill isnt their patient either. We encourage Charles and Daniels to check their PMP report, and they uncover 4 or 5 more suspicious prescriptions, and we just keep pulling at this thread uncovering more and more.
Of course there is potential for abuse and neglect, but we werent (and couldnt, legally) just go into a pharmacy and ask for random documents, or lookup random names on the PMP. We had to have an initial lead, usually a doctor, or a pharmacist, who saw something suspicious. From there, its just checking state records, verifying what we saw with doctors, and getting paper evidence of the stuff we already knew was false. I had maybe 3 cases where we had a red flag, called the doc, and they doc said "Yeah thats legit" and that was the end of the conversation. I don't need to know why this patient is on this narcotic, I just needed to know if it was a fraudulent. If its not, then thats between the doc and the patient.
State law gave us authority to request pharmacy records, i.e. prescriptions and pickup logs, without a warrant. Most pharmacists did it with no hesitation. A few would want to make sure it wasn't a HIPPA violation (it wasnt) and that it was legal (it was).
Concerningly, I did have a_couple instances where I asked for documents and the employee started to provide them before I had a chance to identify myself.
In summary, if we were to blindly look at someones medical history or records without a bona fide articulable suspicion of a crime, it'd be massively illegal. If we did have a reason to look at the records, its because someone in the medical field saw something suspicious and reported it. From there we were mainly looking at records the government already had, and then finally getting medical records from the pharmacy that was just paper evidence of records we already had.