How to Spot a Prescription Mill

There is one sign that tells you more than all the others combined: whether the fee depends on the outcome. If you only pay when you are approved, the person deciding whether to approve you is being paid to say yes.

Telehealth made a lot of good care reachable. It also made it very cheap to build something that resembles a medical practice from the outside: a landing page, a payment processor, a form, and a licence somewhere. The clinical part is the expensive part, and it is the part that gets removed.

What follows is not about aesthetics. Plenty of legitimate practices have unremarkable websites and plenty of mills have excellent ones. These are structural signals about how the operation makes money and where the decision actually gets made.

The one that matters most: a fee tied to the outcome

Look for "you only pay if approved," "money-back if you don't qualify," or a price that only appears after you are told you are eligible.

Consider what that does. The clinician's employer is paid when patients are approved and not paid when they are not. Every "no" is revenue foregone. Nobody has to be corrupt for that structure to bend outcomes — incentives work quietly, through borderline cases resolved generously and questions not asked.

The alternative is not complicated. A consultation fee covers the clinician's time and independent judgement, and is charged whether the answer is yes, no, or "not until we've dealt with something else first." That is how a fee is structured when the practice sells assessment rather than product.

Ask directly, in writing, before you pay: is this fee refunded if I am not approved? The answer tells you what you are buying. This applies across every category — cannabis certification, weight-loss medication, testosterone, ketamine. The structure is the same wherever it appears.

No medical history is taken

A real evaluation needs your history: existing conditions, current and past medications including over-the-counter products and supplements, allergies, surgeries, relevant family history, alcohol and substance use, pregnancy status. It needs to know what you have already tried and what happened.

This is not bureaucracy. It is where contraindications are found. Whether a GLP-1 is appropriate turns on things like personal or family history of medullary thyroid carcinoma, MEN2, pancreatitis and gastroparesis — the list is specific and it matters. Whether ketamine is appropriate turns on psychiatric history including psychosis, cardiovascular history, substance use and pregnancy. Whether cannabis certification is appropriate turns partly on what else you are taking.

An intake that asks your age, your goal and your card number has not screened you for anything.

A questionnaire with no clinician conversation

Some legitimate models use asynchronous review, where a clinician reads your submission and responds without a live call. That can be done properly, and for low-risk situations it is reasonable.

The distinction is whether a licensed human actually reviewed it and could ask you something. Warning signs: instant approval, no possibility of a follow-up question, no named reviewer, a "consultation" that is a confirmation email. For controlled substances a form alone is not adequate, and the legal requirements for remote prescribing of them keep changing — verify the current position with the DEA rather than with a clinic's marketing.

"Guaranteed approval"

Sometimes explicit. More often phrased around it: "98% approval rate," "we've never turned anyone away," "approval in minutes, guaranteed."

No clinician can promise the outcome of an evaluation they have not conducted. If the outcome is knowable before the assessment, there is no assessment. A high approval rate might be honest — people who self-select into a service often do qualify — but leading with it as a promise advertises a foregone conclusion, which is precisely what a clinical decision may not be.

No named clinician and no stated licensure

You are entitled to know who is treating you. Their name, their credentials, and the states in which they hold a licence. Generally a clinician must be licensed in the state where you are located at the time of the consultation, not where they or the company sit — which is why the list matters and why a site that omits it is omitting the thing you would check.

State medical and nursing boards publish licence verification tools, free to use. Name plus state gives you licence status and any disciplinary history in about a minute. A practice that names its clinicians is inviting that check. One that refers only to "our medical team" or "board-certified providers" without names is not.

The rest of your entitlements — consent, records, privacy, referral, refusal — are set out in your rights as a telehealth patient.

No follow-up and no monitoring

For most of what telehealth prescribes, the prescription is the start of the care, not the end.

Testosterone replacement requires periodic bloodwork — haematocrit in particular, because erythrocytosis is a real risk — and a monitoring schedule is part of the treatment rather than an optional add-on. GLP-1 medications need dose titration guided by tolerability and a route to report side effects. Ketamine requires structured check-ins with the prescriber and a plan for when things go badly — the full picture is in at-home ketamine safety.

Signs that follow-up is decorative: refills issued automatically with no clinical contact, no scheduled labs, no way to reach a clinician between appointments, support that is a chatbot with no clinical staff behind it, and a subscription that renews indefinitely without anyone reassessing whether treatment should continue.

Pressure at the point of decision

Countdown timers on a booking page. A discount that expires today. A larger package offered mid-consultation. Automatic enrolment in a recurring plan with cancellation buried in an account page.

Urgency is a sales technique with no clinical function. A treatment appropriate for you today is still appropriate next week, and if it genuinely isn't, that is an emergency and belongs in an emergency room rather than a checkout flow.

What a legitimate practice does instead

The contrast is more useful than the warning list, because it is what you should be looking for.

• Charges for the consultation regardless of outcome, and says so plainly before you book.
• Takes a full history, including medications, and asks follow-up questions when something in it needs clarifying.
• Names the clinician and states where they are licensed, so you can verify both.
• Tells patients no, and is willing to say so on its website. A practice that describes what would rule you out is describing a real assessment.
• Explains regulatory status accurately — that compounded preparations are not FDA-approved, that a given use is off-label, that a state programme does not override federal law. This is the area where the weight-loss market is loosest.
• Has a monitoring plan appropriate to the treatment, and a way to reach a human between appointments.
• Refers out when the problem needs in-person assessment, imaging, examination or emergency care.
• Publishes real terms and a real privacy policy, and does not leak your visit to advertisers — which is a live problem covered in telehealth privacy and tracking.
• Makes no outcome promises. No cures, no guarantees, no "life-changing."

Where telehealth genuinely fits

None of this argues against remote care. Telehealth handles follow-up, medication management, mental health treatment and chronic disease review perfectly well, and for people at a distance from services it is the difference between care and no care. It is unsuitable for anything requiring hands-on examination, imaging or urgent intervention, and never appropriate for an emergency — in a medical emergency call 911, and for a mental health crisis call or text 988. The boundary is set out in what telehealth is actually good for.

Our answers on fees, eligibility and what an evaluation involves are on the FAQ page, and a consultation can be booked here. The fee covers the clinician's time and judgement. Sometimes the judgement is no.