DEA Investigation - 100 FAQs on Opioid Investigations by the DEA
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DEA Investigation – 100 FAQs on DEA Opioid Investigations

DEA Defense Attorney Dr. Nick Oberheiden

The practice of authorizing and dispensing controlled substances has dramatically changed since the Justice Department announced to fight the national opioid crisis by vigorously prosecuting prescribers and corroborating pharmacies across the country. The essence of the government’s claim is that many of the close to 50 billion annual dosages of prescribed controlled substances are medically unnecessary and thus violative of the Controlled Substances Act (CSA). Since the Justice Department’s announcement, physicians and pharmacy owners across the nation have been prosecuted and criminally charged in federal courts. Purpose of this FAQ summary is to provide answers to some of the most pressing and common questions in the context of current DEA opioid and narcotics investigations.

Visit the end of this blog post for recent case outcomes and disclaimer.

Featured by media stations in all 50 states for his federal litigation practice, healthcare fraud defense attorney Dr. Nick Oberheiden has vigorously (and successfully) protected the licenses, livelihood, and liberty of physicians and pharmacies in DEA, FBI, and IRS government investigations across the United States.


Part I: Background Information About Current Opioid Investigations

What Is Drug Diversion?



Drug diversion describes the unlawful distribution of legally obtained medications. Unlike illicit drugs
like cocaine or heroin, drug diversion in the context of controlled substances in form of pain
medication assumes that the patient presents himself or herself with pain symptoms, receives a doctor’s
prescription, and then trades or sells some or all of the pills unlawfully to a third-party.

What Is a Pill Mill?



The term “pill mill” is commonly used by law-enforcement (and the media) to describe a physician’s office
or pharmacy that dispenses large quantities of medically unnecessary controlled substances. While there
are no set standards or rigid criteria as to what constitutes medically unnecessary or excessive
medications, the generic test applied by law-enforcement is whether the dispense of controlled
substances falls within or outside the accepted standards of medicine as used under the Controlled
Substances Act. What makes “pill mills” targets of criminal investigation is the medically inappropriate
and unnecessary, ongoing or repeated prescribing of high dosage medications that are known to be
particularly addictive.

What Is Prescription Fraud?



Prescription fraud is a generic term that is used to describe the issuance of controlled substance
prescriptions that the government considers excessive and medically unnecessary and thus in violation of
the controlled substance Act.

What is the DEA?



The Drug Enforcement Administration (DEA) is divided into 22 domestic regional field offices. The DEA
investigates, often with other federal law-enforcement agencies such as the Federal Bureau of
Investigation (FBI) and agents of the Office of Inspector General (OIG) on behalf of the Department of
Justice. The current 22 regional field offices are located in: Atlanta, Chicago, the Caribbean, Dallas,
Denver, Detroit, El Paso, Washington DC, Houston, Los Angeles, Louisville, Miami, New England, New
Jersey, New Orleans, New York, Philadelphia, Phoenix, San Diego, San Francisco, Seattle, and St. Louis.
Mission of the DEA is to investigate and combat all unlawful use, manufacturing, or distribution of
drugs, be it illicit street drugs or drugs inappropriately prescribed by medical providers.

What Causes DEA Opioid Investigations?



Most opioid investigations originate from one of three events. First, the DEA uses its database and
simply compares the number of your controlled substance prescriptions with other doctors of similar
specialty in your area. Second, either through patient complains or a commercial insurance audit of your
patient charts, the DEA begins to send undercover agents as “fake” patients to your office to see how
“easy” it is to obtain narcotics. Third, the DEA becomes aware of your practice (for example through a
False Claims Act investigation or a tip from a pharmacy), contacts former or current employees, and then
uses confidential informants to gather information about alleged misconduct at your clinic.

Who Are the Targets of DEA Opioid Investigations?



The targets of current DEA administrative and criminal opioid investigations fall into three groups: (1)
medical providers, (2) pharmacies, and (3) veterinarians. First, recent cases have illustrated that the
government does not distinguish between physicians specialties but simply looks at the number of total
issued prescriptions of targeted doctors (e.g. family medicine doctors, rheumatologists, internal
medicine doctors, psychiatrists, nurse practitioners etc.), not the physician’s specialty. Second,
pharmacy investigations and raids were first reported in Nevada and have since extended to pharmacies
nationwide that have alleged illegal ties to prescribing physicians or that showed up as outliers with
unusually high controlled substances fillings. Third, larger veterinarian clinics are on the radar for
drug diversion caused by stealing employees and owners of injured animals.

Why Is the DEA Going After Veterinarians?



Veterinarian offices have become targets of DEA search warrants in several states, including, for
example, in Chicago, Illinois. Just like physicians for human beings, veterinarians do administer pain
medications to their (animal) patients. In particular large veterinarian clinics, surgery centers, and
animal hospitals maintain narcotics for emergencies and postoperative use that attract desperate and
addicted animal owners to engage in diversion, fraud, and abuse. Case law has shown how animal owners
have engaged in veterinarian shopping to fraudulently obtain pain medications for their animals— with
these narcotics ending up being consumed by the owners themselves. In addition to abuse by animal
owners, the DEA has become aware of instances, in which staff members of vet clinics have stolen
narcotics from the clinic’s secured medication storage units and thus imposed liability on the
veterinarians, DEA license holders, and clinical owners.

What Are the Main Targeted States?



According to statistics, the rates of opioid prescriptions dispensed per 100 persons by dosage and type
exceed the national average in a number of states. The states under particular government scrutiny are:
Alabama, West Virginia, Arkansas, Tennessee, Mississippi, Oklahoma, Kentucky, Louisiana, South
Carolina, Michigan, North Carolina, Oregon, Delaware, Missouri, and Nevada
. Because the DEA
applies a purely numeric data-driven approach when it comes to identifying their prioritized targets,
high volume prescribing physicians and pharmacies in those states are most likely to be contacted by

Which States Have the Highest Opioid Related Overdoses?



Approximately 90 people die in the United States of a drug related overdose every day. That number has
gotten the attention of federal law-enforcement when it became clear that many of these fatalities are
at least partially caused by high-dosage narcotics. One of the key selection criteria for the Justice
Department and the DEA to prioritize opioid investigations is a look at the total number of
prescriptions per physician. According to the DEA, the states with the highest rates of drug overdose
deaths are: West Virginia, New Hampshire, Ohio, bring the island, Pennsylvania, Massachusetts, New
Mexico, Utah, Tennessee, Connecticut, Delaware, Maine, Maryland, Michigan, Indiana, Louisiana,
Arizona, and Oklahoma.

What Are Current Opioid Lawsuits About?



A number of cities, counties, and states have brought state and federal lawsuits against opioid
manufacturers and drug distributors. Cities like Philadelphia, Dallas, and Chicago claim that
pharmaceutical companies and large pharmacy conglomerates have caused or contributed to drug addiction,
illegal drug use, and accidental overdoses resulting in damages and financial losses for municipalities,
state owned facilities, and hospitals. In one of the largest of these class actions, a federal judge in
Cleveland, Ohio has so far rejected almost all objections raised by the defendants to end or to limit
the scope of these pending lawsuits; the case is scheduled for trial in 2019.

Do Physicians Have Exposure in Pending Civil Lawsuits?



Plaintiffs’ lawyers in civil lawsuits against drug manufacturers frequently also sue physicians arguing that
it the physicians’ prescriptions and their alleged lack of professional care that have contributed to the
current national epidemic. While these lawsuits are civil in nature, the true risk for physicians is to be
forced to testify under oath in a deposition or in court about their prescription policies—with the DEA
closely monitoring and observing these proceedings in an effort to build criminal cases based on the
physicians’ testimony. Any physician sued in state or federal court for medication abuse and opioid
mismanagement allegations should consult with the best DEA criminal defense attorney to make
sure that the compelled testimony does not lead to accidental self-incrimination.


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Part II: Signs that You May Be Under DEA Investigation

What Are Signs that My Practice Is Under Investigation?



Signs of an investigation can stem from overlapping rumors or concrete actions by the government. Most people
first become aware of an investigation when they hear rumors that agents have, for example, interviewed
patients or former employees. While these rumors may or may not be credible at times, a pending
investigation becomes obvious when your business receives correspondence from a private insurance company or
a government agency. Common examples of subpoenas and written notifications are OIG subpoenas, Grand Jury
Subpoenas, a Civil Investigative Demand (CID), a DEA patient file subpoena, as well as, not to
underestimate, an audit request from commercial insurance carriers. A more dramatic way of learning about a
pending case is when federal agents show up at your office to interview you or to execute a search warrant.
If you experience any of these events, you must immediately consult with the best federal defense attorney to avoid further
investigation and criminal charges.

What Should I Do When a Commercial Insurance Carrier Wants to Audit My Patient Charts?



Many healthcare business owners grossly underestimate the investigative connection between commercial
insurance companies (e.g. Blue Cross Blue Shield, Aetna, CIGNA) and the Department of Justice. The old
assumption of federal law enforcement on the one hand and private insurance companies on the other
hand has long been obsolete. Today, a great number of federal indictments rather exclusively claim private
health insurance fraud. If your business receives an audit request from a private insurance company
targeting your prescription policies or your chronic pain treatment protocols, it is absolutely possible
that an unfavorable audit outcome may be shared with the U.S. Attorney’s Office. The best practice is to
visit with an attorney with the experience and track record of settling patient chart audits and subpoenas
quickly and efficiently before a criminal referral will be made—regardless of the error rate and
irrespective of how negative the audit outcome may be.

What Should I Do When the DEA Shows Up at My Pharmacy?



When DEA drug diversion investigators arrive at your pharmacy, you should immediately consult with
experienced attorneys. Federal law entitles the DEA to inspect a pharmacy at any time during regular
business hours as long as such inspection does not interrupt the pharmacy’s business operations. Because a
pharmacy’s compliance is mandatory, you should not engage in a confrontation with the auditors or refuse
entry as such reaction could prompt the investigators to obtain a criminal search warrant. Instead, you
should seek advice from the best defense attorneys right away. The involvement of respected lawyers will
typically create a more pleasant and functional relationship with the auditors. Quite often, the best
DEA defense lawyers will be able to secure a 48-hour extension before the audit can begin. Such negotiated
delay can be based on a number of reasons and it allows the pharmacy, together with its attorneys, to
prepare the upcoming inspection and to fix potential shortcomings in the meantime.

What Should I Do When I Receive a DEA or OIG Subpoena?



Immediately call an experienced attorney. If your business is targeted by a government subpoena, you must
assume that there is an advanced, ongoing investigation against your business that must be stopped as
quickly as possible.

Do I Need to Comply With a DEA or OIG Subpoena?



Yes, government subpoenas are enforceable in court. More important than complying with the subpoena is the
intervention of the best healthcare fraud defense attorney. Your lawyer must immediately open a line of
communication with the prosecutor to discuss the goal and scope of the investigation. Ultimately, these
discussions can lead to a meeting with the prosecutor, in which a case resolution can be negotiated.

What Is Required for the DEA to Obtain a Search Warrant?



In order for the DEA to obtain a search warrant, the investigators must convince a federal judge that there
is “probable cause” to find evidence of a crime at the location to be searched. In practice, investigators
will collect information from informants, their own observations, and public databases of prescription
volumes, in an effort to put together an affidavit outlining the alleged crime and why evidence of the crime
is likely located at the targeted office. The “probable cause” standard can also be fortified by a detailed,
written synopsis of conducted witness interviews, such as from current or former office staff.

Are Opioid Related DEA Search Warrants of Pharmacies and Physician Offices Common?



Yes, DEA search warrants have become a powerful tool for the government to get rapid access to patient files,
financial records, and corporate documents. Previously, the more common practice was for the DEA to issue a
subpoena requesting specifically identified charts and documents. Today, the government simply takes it all,
seizing patient files and entire computer systems from the clinic premises leaving the raided office in a
state of chaos.

Should I Surrender My DEA License Upon an Agent’s Request?



No, you should not surrender your DEA privileges unless a qualified attorney recommends or advises to do so.
These days, physicians feel pressured by DEA agents requesting a voluntary surrender of the physician’s DEA
license under the false pretense that such surrender will protect the doctor from further investigation. The
truth is that there is almost never a correlation between giving up a DEA license and closing an
investigation. The DEA license is issued and revoked by the Drug Enforcement Administration, while the
decision to pursue or end a civil or criminal investigation lies exclusively with the local U.S. Attorney‘s
Office and the Justice Department. Experienced attorneys will use a DEA license as leverage in case there is
a need to actually negotiate a reliable and final investigation outcome. Promises made by a DEA field agent
to a physician simply do not have the same level of reliability as promises made by a prosecutor to a
defense attorney.

What Should I Do When I Notice Compliance Problems?



When you notice compliance problems or if you realize that with today’s knowledge and understanding of opioid
investigations you may have treated some patients in the past differently, you should immediately consult
with the best attorney to get concrete advise how to improve and protect your practice. Everyone is eager to make
changes after the DEA and the FBI show up at an office. The key is to prevent any encounter with
law-enforcement and to organize your practice to the highest compliance levels before you receive a
visit or subpoena from investigators.

What Are Potential Outcomes if My Practice Is Under Investigation for Opioid Fraud?



Opioid investigations can run the entire spectrum from no liability, to administrative penalties, to criminal
prosecution. The key in each case is to consult with experienced attorneys with specific track records in
DEA medication cases as early as possible to execute effective and proven defense strategies.


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Part III: How the DEA Investigates Opioid Fraud

Who Investigates Opioid Fraud?



The Department of Justice, local U.S. Attorney’s Offices, federal and state prosecutors, the Drug
Enforcement Administration (DEA), the Federal Bureau of Investigation (FBI), the Office of Inspector
General (OIG), and the Internal Revenue Service-Criminal Investigation (IRS-CI) are the main agencies to
investigate prescription abuse and opioid fraud.

Should I Allow Agents to Interview Me at My Office?



Absolutely no. When DEA or FBI agents show up at your office or your house, all of your alarm systems
must go off. While it is tempting to engage in a conversation with the agent (especially when they
assure you that they just have a few questions and that the case is not about you, and you feel like you
have nothing to hide because you did not do anything wrong), the only correct advice is to not discuss
anything with the agents and to politely decline the interview request. Why? First of all, if federal
law-enforcement takes the effort to visit you, you must assume that you are a person of interest of a
federal criminal investigation. Second, anything you will share with the agents will be held against you
and is the equivalent of testifying in court. Third, while it is a federal felony for you to withhold,
misrepresent, or lie about material facts in the presence of a federal officer, the agents themselves
can and will lie to you by downplaying the interview in order to break the ice and to make you

What Is the Significance of a Search Warrant?



A search warrant is a meaningful event in a federal criminal investigation. Unlike a subpoena or an audit
request, a search warrant involves and requires a federal judge to agree with the investigators that a
crime has probably occurred. Also, in terms of timing, a search warrant is typically the last
preparatory step before criminal charges will be filed. What the government really tries to do when
executing a search warrant is to find documents and information that confirms the assumption of criminal
conduct and to secure evidence sufficient to convince a grand jury to issue criminal charges based on
the documents seized, reviewed, and presented.

What Is the Role of the Grand Jury in Federal Criminal Cases?



Pursuant to the Fifth Amendment to the U.S. Constitution, the role of the grand jury in a federal
criminal case is to determine whether or not to bring formal criminal charges against a targeted
individual or company. The grand jury is selected similar to a regular trial jury. A grand jury consists
of 16 to 23 people, who convene typically every two weeks somewhere within the local federal courthouse.
Because criminal defense attorneys have no right to access the grand jury deliberations and thus no
opportunity to introduce exonerating information in defense of a target, the government has a
significant advantage by presenting a one-sided story.

What Is a Grand Jury Subpoena?



Subpoenaed documents are key components for a grand jury to reach their decision whether or not to charge
somebody with a crime. The way for the grand jury to obtain such documents is to issue grand jury
to individuals and companies that are expected to have information about a particular case. For example,
a medical business is under investigation for billing fraud, outside vendors of that medical practice,
as the utilized outside billing company, could receive a grand jury subpoena requesting detailed billing
patient records with respect to the targeted medical business.

Are the DEA and the Medical/Pharmacy Board Working Together?



The DEA and state medical boards are working closely together and will exchange information and
coordinate the status of an investigation in some, but not all states. For example, in New Jersey,
Pennsylvania, and Virginia, medical boards and DEA agents have built close relationships and often work
as teams, while in other states investigations are exclusively handled by law-enforcement without
integration of medical board or pharmacy board investigators.

Will the DEA Report Me to the Medical Board?



The DEA will report alleged misconduct to your licensing board in one of two instances. One, the
government believes that your practice of issuing high dosage prescriptions constitutes a threat to
public safety. Two, the government decides to indict you with federal felony charges.

Will the DEA Record My Conversations?



Recorded conversations have become more common in white-collar investigations in recent time. Recordings
occur in two situations. First, someone that you trust or want to do business with may work as an
informant for the government and will attempt to entice you into admitting criminal misconduct—for
example, to avoid criminal prosecution against himself. Second, because the government increasingly uses
“fake” patients, undercover agents or confidential informants may record your interactions with them at
your office.

What Types of Financial Relationships Between a Referring Physician and a Pharmacy Are Prohibited Under
the Anti-Kickback Statute?



The federal Anti-Kickback Statute prohibits certain types of financial business relationships between
people that have the ability and are in a position to refer patients and a business partner (e.g.
hospital, pharmacy) paying or attempting to pay remuneration for such referrals. Kickbacks are never a
one-way street and always involve two parties. Both, the paying and the receiving of anything of value
constitute a federal felony if the deal directly or indirectly involves patient referrals. In the
context of opioid fraud, the government will look for referral patterns and potential compensation
arrangements between referring physicians and a pharmacy.

Are Pharmacies Required to Report Suspicious Prescriptions?



Yes, pharmacies are required to report suspicious prescription practices such as routine or automated
fillings of high dosage opioids, potentially forged physician signatures, and other forms of drug
diversion. If your practice receives a letter from a pharmacist-in-charge inquiring about your
prescription habits or articulating concerns, you should immediately visit with a healthcare defense attorney to
investigate and fix potential problems before the DEA gets involved.

Are Physicians Liable for Forged Prescriptions?



Yes, liability may arise if the forgery was made possible due to negligence or recklessness. If, for example,
a physician shares access to prescription pads with his staff or allows his/her signature to be stamped or
used electronically, the physician may well be civilly and criminally liable for forged prescriptions.

Are Physicians Liable for Stolen Prescription Pads?



Yes. Physicians with DEA privileges are required to keep their prescription pads and sample medications in a
secure, locked storage unit with access limited to the prescriber himself or herself. Medical providers
acting contrary to these mandatory safeguards may be subject to federal penalties, a loss of their DEA
license, and possible prosecution.

What Happens in an Opioid False Claims Act Investigation?



The False Claims Act penalizes the submission of false or fraudulent claims to insurance companies or
federally funded programs. False or fraudulent in the context of opioid investigations can be billing for
services (e.g. physical examination, consultations with patients etc.) that did not occur. A claim can also
be fraud if prescriptions are administered or authorized that turn out to be medically unnecessary. False
Claims Act violations can be civil or criminal in nature and expose the responsible party to monetary
penalties and even criminal prosecution.

How Many Medical Providers Have Been Charged with Felonies for Opioid Fraud in 2018?



Lacking official statistics, according to media reports, approximately 100 physicians have been criminally
charged in recent months with hundreds of civil and criminal prosecutions against pharmacies, pharmacy
owners, physicians, nurses, nurse practitioners, and healthcare business owners pending nationwide.

How Many Medical Providers Could Be Prosecuted Until 2020?



Listening closely to the Attorney General and serving on the defense frontline of current investigations, an
estimated 1,000 physicians and pharmacy owners may be prosecuted for pain medication and opioid fraud over
the next two years.


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Part IV: Defense Strategies

What Is the Most Important Thing to Do to Defend Against DEA, OIG, FBI, and IRS Opioid Fraud Investigations?



Nick Oberheiden has successfully defended physicians and pharmacies against opioid and healthcare fraud
investigations across the country. The key is to understand healthcare laws and to have the skillset to
lead negotiations with federal prosecutors and investigators—and to intervene as early as possible into the
government’s case.

What Are Proven Defense Strategies in Opioid Fraud Investigations?



Nick Oberheiden has convinced government prosecutors and DEA agents in a plethora of cases that a) his
client’s prescriptions were medically necessary, b) his client practiced within the accepted standards of
medicine, c) his client had no intent to violate the law, d) his client has demonstrated sufficient
compliance efforts to prevent drug diversion, e) the government’s search warrant was premised on wrong
assumptions, f) the government’s search warrant resulted in no findings, g) renowned experts confirmed the
client’s compliance with ethical obligations, h) the government’s expert lacks the necessary qualifications,
and many more. Ask Nick directly for a case specific analysis.

How Does the Government Determine Which Prescriptions Are Medically Necessary?



Medical necessity is among the biggest battles in every DEA opioid investigation. Although prosecutors know
as little about medical necessity as

defense attorneys, almost every government agent and government lawyer
will claim that the defendant’s prescriptions were excessive and not medically indicated. The true solution
to the mystery of medical necessity is not for blinded lawyers to engage in the unauthorized practice of
medicine, but for the best defense attorney with ties and connections to renowned medical experts, to
obtain a high-level, professional analysis of the targeted physician’s prescription practice.

Is My Phone Wire-Tapped?



One of the most common concerns for anyone under actual or perceived investigation by the federal government
is the question of wiretapping. Against common misconception, the government’s authorization to conduct
extensive surveillance and even tapping and interfering into phone systems is subject to heightened legal
obstacles and remains limited almost exclusively to organized crime cases, investigations involving national
security, gang violence, terrorism, kidnapping, and similar (violent) crimes. Subject to few exceptions, the
chances that your phone is wiretapped are very slim when your case centers on prescriptions or general
healthcare fraud.

Can I Discuss My Case with Friends and Family?



No, you should not discuss details of your case or admit wrongdoing in front of anyone except for your
lawyer. The natural tendency for people is to chat and to talk and to share their feelings and concerns with
trusted and loved people. If you are under government investigation, however, you should put protection
above communications and refrain from texting, emailing or discussing your case with anyone except for your
trusted attorney of record. Text messages and emails can be subpoenaed and, if deleted, restored. More so,
the person that you share thoughts and information about your case can be compelled to testify about your
conversation with him/her unless that person is your attorney.

What Is the Attorney-Client Privilege?



The attorney-client privilege describes the protected confidentiality between an attorney and a legal
advice-seeking client. An attorney must not disclose anything that the attorney learns during the
representation of a client to anyone and no court can force an attorney to testify about legal advice given
to a client unless an exception applies.

Is the Attorney-Client Privilege Absolute?



No, there are two main exceptions to the attorney-client privilege. First, the privilege may be jeopardized
if the client shares legal conversations the client had with an attorney to a non-attorney third-party like
a friend, and office manager, or a business affiliate. Second, the attorney-client privilege does not
protect clients who are seeking legal advice to commit a crime.

Are My Conversations with My Spouse Protected?



In general, yes. Parallel to the attorney-client privilege, spousal immunity is a second, recognized form of
confidentiality in a criminal case. The scope of the immunity is simple. Anything you share with your spouse
about a legal issue is protected. As long as you are married at the time of the confidential conversation,
your spouse cannot be compelled to testify against you. However, and here is the risk, your spouse may
always voluntarily disclose all conversations to the government at the spouse’s discretion. That is a risk
factor, in particular if the marriage results in a contested divorce.

When Does the Spousal Immunity Not Apply?



Just like any legal privilege, there are exceptions. The spousal privilege is most frequently challenged if
the government claims that the protected spouse is a potential co-conspirator, who knew for a long time that
a crime was occurring. The classic illustration of that objection is when the spouse has some functions or
duties at the targeted office by, for example, working at office as an officer manager or helps the business
with accounting services.

Are My Conversations with My Accountant Protected?



No, federal law does not protect conversations between an accountant and a client and all records in the
possession of an accountant, including confidential tax returns and financial information, can be subpoenaed
by the government.

What Is the Worst-Case Scenario in a DEA Opioid Investigation?



The worst-case scenario in a DEA investigation is that you will lose your medical license and will go to
federal prison. Recent examples have exemplified the aggressiveness with which the government is prosecuting
alleged opioid fraud. In several cases, the government has tried to secure life sentences against physicians
for prescribing controlled substances to patients that accidentally died of a drug overdose. About 90 people
die each day in the U.S. due to drug overdoses, some of which are contributed by pain medications. Equally
horrific, several states have charged physicians with “homicide” for allegedly causing or contributing to
the death of a patient
under that doctor’s medical care.

Who Is the DEA Using as Confidential Informants?



The DEA is using confidential informants to gather information and evidence about targeted physicians’
offices. Today, many opioid related indictments and search warrant affidavits reference the contributions of
a physician’s office manager, medical assistant, or front desk staff that the FBI or the DEA convinced to
serve as informants to secretly provide documents, impressions, observations, pictures, and recorded
conversations leading to criminal allegations of pill mill operations. Every clinic owner and every
practicing physician should act extra professional and extra diligent when it comes to patient and staff
member interactions at all times and should avoid jokes, casualty, or impressions of unprofessionalism.

Is the DEA Using Undercover Agents as “Fake” Patients?



Yes, besides staff members serving as confidential informants, the DEA frequently uses its own investigative
agents to pose as “fake” patients. These patients are hard to identify because they are not just trained to
appear like regular, normal patients, but they are also often using aliases with specially created health
care insurance coverage (and not the otherwise applicable Department of Labor coverage typically used for
federal employees). Mingled with regular patients, these undercover agents will visit the practice in an
unsuspicious frequency, use recording devices, and hidden cameras to capture specific misconduct or general
impressions of a “pill mill” operation. For example, in several cases, undercover agents reported pre-signed
prescription pads, office staff selling prescriptions in exchange for cash, lack of medical examination or
supervision, and similar characteristics of improper handling of controlled substances.

What Is the Statute of Limitations in Healthcare Cases?



The general Statute of Limitations for healthcare fraud is five years. However, the statute enumerates
several exceptions allowing the government to charge alleged offenses that have occurred more than five
years ago under certain circumstances. Because federal cases tend to be complex and take years to
investigate, most federal criminal charges will claim misconduct dating back not weeks or months but
typically several years ago. For example, for someone to be charged with healthcare fraud in late 2018, the
indictment would likely alleges fraud occurrences somewhere between 2014-2017.

What Is the Main Goal When Defending Against the DEA?



Priority in every DEA case is to avoid criminal charges and to protect the provider’s professional license.
Even though many DEA investigations begin as a criminal case, the best attorneys, if engaged early in the
case, are often able to use their healthcare law defense expertise to convince DEA agents and federal
prosecutors to convert a criminal case into a civil liability matter. The longer an investigation has been
pending without forceful objection by counsel, the more difficult it is to turn a criminal case into a civil
case. In other words, if you visit with an experienced attorney at the earliest indication of an
investigation against your business, chances of avoiding criminal charges are disproportionately higher than
you waiting until after a search or arrest warrant has been executed against you.

Why Are IRS Agents Involved in My Case?



If IRS agents are involved in a narcotic search warrant or an opioid investigation that means that the
government expects you to have either committed money laundering or tax fraud. Because private pay patients
can contribute large amounts of cash, IRS agents will typically subpoena your tax returns to see if your
reported income matches the calculations of health insurance and federal program reimbursements in addition
to monies received from private pay patients. What you should avoid under all circumstances is a two-front
war against the DEA for opioid fraud and the IRS for tax evasion. Help is simple and effective to avoid such
a situation.

Will I Go to Jail If the DEA Investigates My Practice?



DEA narcotics investigations do not necessarily result in jail time or criminal charges. The key to a
successful case outcome is the timing and the experience of an intervening defense attorney. The sooner a
lawyer with substantial experience of handling FBI and opioid investigations can contact, speak with, and
find a resolution with the high-level decision makers, the more likely it is to avoid fines, charges, and
public humiliation. In fact, almost every DEA search or arrest warrant is the consequence of failed legal
representation and the defendant’s ignorance of the signs (e.g. patient audit request, government subpoena,
attempt by law enforcement to interview witnesses, etc.) that predate criminal events and court intervention.
The past success record of the lawyer of avoiding fines and criminal charges should be an essential element
of your interview questions before hiring any attorney.

I Am not a U.S. Citizen: Will I Be Deported?



Non-U.S. citizens are particularly exposed in criminal cases. You will not be deported unless you plead
guilty to or are convicted of an aggravated felony. Healthcare fraud is an aggravated felony. Please seek
legal advice right away to coordinate immigration and criminal defense strategies.

What Are the Consequences of Pleading Guilty?



The consequences of pleading guilty can be severe and may affect your professional license, your ability to
work in the healthcare industry, and your freedom. Because virtually all state medical and pharmacy boards
have a mandatory provision to disbar convicted felons, medical providers will risk losing their professional
license if they admit to a federal felony such as healthcare fraud or are convicted at trial. In addition,
the guilty plea typically entails a prohibition to work in the healthcare industry or to bill Medicaid and
Medicare services. Previously authorized providers will be excluded by CMS. Finally, a guilty plea must be
carefully reviewed prior to acceptance in order to understand the framework of the potential criminal
penalty. Some plea agreements will have a cap and define the maximum sentence a defendant could possibly
receive at sentencing in court, while other pleas only contain an agreement as to the facts, the nature of
the offense, and the defendant’s guilt.

Should I Plead Guilty or Go to Trial?



The decision to plead guilty or to present your case to an unbiased jury at trial is one of the most
difficult decisions in any criminal case. The best defense attorneys, familiar with all facts, good and bad,
ultimately must decide with their client whether at least one out of twelve jurors would disagree with the
government’s story. The decision typically comes later in a case when all the evidence and facts have been
established and evaluated. Importantly, the pressure from the government to force you into a plea by
threatening more or additional charges if you go to trial should not be the true factor for you to surrender
your rights and accept a plea. If you can’t honestly say in front of a federal judge and under oath that you
did something wrong and that you did so with criminal intent, you shouldn’t plead guilty.


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Part V: How Can I Protect My Business?

How Can I Protect My Practice from a DEA Investigation?



The best way to protect your practice against any encounter with law-enforcement is to be vigilant when it
comes to prescription policies and your handling of controlled substances. If you regularly prescribe pain
medications, you should visit with an experienced attorney who is qualified to analyze your practice and
able to review sample patient charts in order to assess whether or not you may have any exposure in light of
current opioid audits and investigations.

How Can I Demonstrate that I Don’t Have Any Criminal Intent?



The government won’t take an x-ray of your brain to see whether you had any bad intent. The burden is on you.
You must demonstrate through your documentation and your operations that nothing is more important to you
than complying with state and federal laws.

What Is the Purpose of an Opioid Compliance Program?



One way to demonstrate your efforts to be compliant is to implement an opioid compliance program at your
pharmacy or clinic. Compliance is typically a three-step process: establishing a program, monitoring
compliance, and enforcing compliance. Consult with healthcare fraud defense attorneys which program may
best fit your practice.

What Is a Prescription Contract?



All physician offices that issue any form of prescriptions should have all patients sign a Prescription
Contract at the first office visit. The contract will legally bind a patient to follow the office’s
guidelines, to adhere to the physician’s orders and instructions, and set clear demarcation lines of
permissible and tolerable as well as prohibited patient behavior.

What Happens During an Internal Investigation?



The best preventive defense strategy for any pharmacy or physician’s office potentially or even remotely
exposed to DEA inquiries is to have experienced attorneys conduct an internal investigation, also known as a
voluntary self-audit. Purpose of the audit is to identify and fix operational and legal issues instead of
(or before) the government may detect them. Prosecutions of healthcare businesses that have conducted a
professional self-audit are very rare, among other reasons, because a voluntary self-investigation
ostensibly demonstrates your intent to do things the right way and not to tolerate any known mistakes.

What Are Acceptable Amounts of Pain Medications?



There are no firm guidelines under the federal Controlled Substances Act that would allow prescribing
physicians or pharmacies to obtain reliable orientation when it comes to the acceptable amounts of pain
medications. However, an analysis of current opioid related indictments and a plethora of negotiations with
prosecutors and government experts in pending DEA investigations allow attorneys like Dr. Nick Oberheiden to
conclude that the government strongly disfavors the routine prescriptions (and auto refills) of high-dosage
narcotics mixed with other controlled substances creating powerful cocktails of Schedule I, Schedule II,
Schedule III, and Schedule IV combinations. For example, in one recent case, the government considered the
following prescriptions sufficient to claim lack of medical necessity and to federally indict the medical
provider: Percocet 10/325 mg, 120 pills; Oxycodone 15 mg, 60 pills; OxyContin 15 mg, 60 pills; Oxycodone 30
mg, 60 pills; and Zanaflex 4mg, 90 pills.

How Can I Prepare My Business for a Worst-Case Scenario?



Generally speaking, the best practice for any business is to have comprehensive policies in place that
address in detail what to do during a search warrant or in case of any other government intervention. These
written policies should address concrete procedures of how to respond to law-enforcement. The policies
should further identify one or two individuals in charge of such a response as well as communication lines
with pre-selected, standby attorneys. Rather than selecting and educating previously unknown attorneys
during an ongoing crisis situation, it behooves business owners to have counsel familiar with the particular
business operations (and the people running the company) preselected so that no time needs to be spent or
wasted when time is truly of the essence.

What Is the Purpose of Having Prescription Policies?



Every prescriber of controlled substances should have a canon of policies and protocols that make it
ostensibly clear under what conditions and circumstances patients may qualify for obtaining a controlled
substance. These policies will address the valid alternatives to medication management, the use and
integration of physical therapy, injections, radiology updates, counseling, and other elements of an
interdisciplinary pain management approach. Similarly, the protocol should address the maximum levels of
scheduled drugs that patients could expect from that prescriber.

What Should My Prescription Policies Emphasize?



Your prescription policies should emphasize your intent to comply with state and federal regulations and
clearly define your dispensing policies when it comes to controlled substances. The prescription policies
should be publicly available on your business’s website as well as acknowledged and signed by your patients
at the first office visit. Supplementing the prescription contract that each of your patients should be
required to sign, the prescription policies address under what circumstances prescriptions or refills can be
called in, what happens in case of lost prescriptions, how patients can obtain their medication from the
pharmacy, and who, in general, qualifies for narcotics and other pain medications.

May I Prescribe Controlled Substances to Family Members?



No, most state laws (e.g. New Jersey, New York, Virginia etc.) prohibit most types of prescriptions to
immediate family members. Immediate family members are typically listed as spouses, children, parents,
grand-parents, siblings, aunts, and uncles. State laws vary.

May I Prescribe Controlled Substances to Staff Members?



No, if not prohibited under state law, you may be accused of a conflict-of-interest if you build a
doctor-patient relationship with your subordinates.

What Type of Doctor-Patient Relationship Is Expected When a Patient Receives Controlled Substances



At an absolute minimum, prescriptions should never be issued without a physical exam and a face-to-face
consultation between doctor and patient. The higher the dosage, the more testing and examinations are

What Are the 10 Most Dangerous Drugs in America?



According to addiction experts, the 10 most dangerous drugs in America are: opioid painkillers, heroin,
cocaine, fentanyl, methadone, alcohol, oxycodone, ketamine, benzodiazepines, and tobacco.

How Do Patients Abuse Painkillers?



There are three classic ways how patients may abuse painkillers. Patients may take a dose other than
prescribed, take someone else’s medicine, or take prescription medicine to fortify the effects of other
drugs or in a way to get high.

Why Did the Government Declare an Opioid Epidemic?



The federal government (and a number of states) declared a national opioid epidemic because of the high
percentage of prescriptions abuse and an opioid-related overdose rate of approximately 33,000 people per

How Many Americans Are Estimated to Abuse Opioids?



Approximately 2-3 million Americans are considered opioid abusers.

What Are the Most Monitored Prescription Opioids?



The DEA monitors the administration of prescription opioids with unprecedented scrutiny. Among the most
investigated opioid prescriptions are: hydrocodone (OxyContin, Percocet, Vicodin), oxymorphone (Opana),
morphine (Kadian, Avinza), codeine, and fentanyl.

How Can I Prevent a DEA Interest in My Practice?



The safest way to avoid the DEA being interested in your practice is to reduce (or avoid) the issuance of
controlled substances prescriptions. Equally important to prescribing less and reducing your maximum amounts
of heavy narcotics, is the overall approach you apply to pain management. The government expects an
interdisciplinary, highly individualized and patient-tailored treatment protocol that incorporates and
orders psychological counseling, physical therapy, surgical referrals, pain procedures, and any other
treatment form designed to wean down the patient’s current medication levels. In terms of patient
compliance, physicians that routinely prescribe controlled substances (e.g. to chronic pain patients)
ultimately must make a decision to either discharge noncompliant patients or to risk becoming a government

How Important Are Urine Drug Tests for Purposes of Opioid Compliance?



Since you can’t x-ray your patients’ brain to see if they plan on following your medication directions, you
are left with monitoring narcotics compliance through urine drug testing. Doing so offers three advantages.
One, toxicology drug test screenings and confirmations are the most objective way to make sure your patients
are not doctor shopping or otherwise engaged in diversion. Two, the demonstrated compliance effort of
testing and monitoring will be noted in the patient’s file and helps justifying responsible drug
administering. Three, those patients that refuse a UDT or fail the test have violated their Prescription
Contract with you and must be responsibly discharged. In terms of frequency, testing should be left to the
doctor’s discretion and may vary among patient genders, patient age groups, the patient’s history of illicit
drug consumption, and the overall patient susceptibility for strictest compliance. For most patients, a
random drug test 3-4 times a year shall suffice.

Is It Legal to Accept Cash Patients?



While it is perfectly legal to accept cash paying patients, physicians should recognize that private pay
patients can create unwanted exposure. With often-limited financial resources, cash patients are less likely
to be compliant with those treatment regimens that the government expects in order to justify the issuance
of controlled substances. Paying out-of-pocket for psychological counseling, chiropractic or physical
therapy, toxicology tests, or expensive pain procedures is simply not affordable for a majority of private
pay patients. And here’s the dilemma. The patients’ financial limitations and inability to follow doctor’s’
orders may force a clinic to discharge some of these patients, even those with a history of compliance.

Do Private Pay Patients Pose a Compliance Risk for My Practice?



One of the biggest challenges for every provider dedicated to caring for chronic pain patients is whether or
not to accept so called private pay patients. There are many reasons why a patient may lack health insurance
(e.g. due to a loss of employment benefits and or other valid reasons). However, seeing through the eyes of
government investigators, cash paying patients are the number one cause of unlawful opioid drug diversion.
Private pay patients are typically not registered with and monitored by state or federal reporting
organizations making their medication habits more difficult to supervise and monitor, in particular for
those patients who travel to physicians in different states or who refuse or are unable to comply with urine
drug tests and interdisciplinary treatment regiments.

When Are Physicians Liable for Patient Misconduct?



Drug diversion can create civil and criminal liability for physicians if there are no precautions or
mechanisms in place designed to prevent non-compliance with the physician’s order. The most effective way to
control and suppress diversion is urine drug testing. Modern toxicology laboratories are able to detect
missing as well as added ingredients in urine samples and can thus determine whether or not the patient
applied the medically ordered prescriptions amounts. Put differently, if a patient’s drug test is
inconsistent with the ordered medications, the physician may be required to discharge the patient or
otherwise risk exposure for participation in drug diversion.

When Should I Discharge a Patient for Non-Compliance?



You should discharge patients when they are not compliant with your treatment orders or if they fail a drug
urine analysis test. Although most physicians would give patients caught with marijuana a second chance,
this leniency should be re-thought and revisited given that marijuana and similar drugs are strictly
prohibited under federal. In other words, if your practice is, for example, in Colorado, where the
consumption of certain drugs is not prohibited under state law, the test for you in terms of compliance is
whether federal law (and the DEA) would allow for the consumption of the drug found in the urine test. When
it comes to controlled substances’ compliance, “second chances” create a real legal risk for a physician,
which should be carefully weighted in light of the aggressiveness of current Controlled Substances Act

Should I Be Concerned About Patient Abandonment?



Yes, patient discharges must not result in patient abandonment. Physicians have an ethical obligation to care
for their patients, including those that are to be discharged. When a discharge occurs, a physician must
exercise good judgment to ensure that the patient is not left in a dangerous medical condition or at risk
for life-threatening withdrawals. The proper discharge protocol must give each patient contact information
of nearby hospitals, names and addresses of new medical providers, and other important information to safely
transition the patient to another provider.

Should I Report Discovered Issues to CMS?



Unfortunately, the CMS self-disclosure reporting is often an inadequate tool to address and rectify
discovered errors for healthcare businesses. Although experienced healthcare defense lawyers like Dr. Nick
Oberheiden have utilized the disclosure protocol to the advantage of his clients, each disclosure comes down
to a delicate risk assessment. The disclosure requires a sworn statement that summarizes the scope and
extent of the disclosed mistakes; but it also requires a sworn certification that the revealed errors
represent the totality of mistakes. The general problem with the self-disclosure is that the government does
not offer any criminal immunity. To the extent the disclosure can be interpreted as a self-incrimination,
the client essentially waives all constitutional privileges and rights leaving the decision to criminally
prosecute the reported misconduct entirely up to the government.

What Should I NOT Do When I Notice Compliance Problems?



What you should not do when you experience drug related compliance concerns is to discuss those with anyone
except for an attorney. Loose lips sink ships!


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Part VI: Selecting the Right DEA Defense Attorney

When Should I Consult with an Attorney Regarding My Prescription Concerns?



Immediately! You should consult with the best attorney immediately if you have concerns about your past or current
prescription practice or if you experience any signs of an investigation, be it an audit, be it agents
showing up at your office, or be it a subpoena issued against you or your practice. The more time you give
the government to investigate you, the more difficult it is for an attorney to effectively intervene. Put
differently, avoiding liability and criminal charges is substantially more feasible than dismissing an
already issued indictment. Put a trusted lawyer to work on your case right away and don’t wait until you
actually have to defend yourself. Invest into your license and future, today!

How Much Experience Should My Lawyer Have?



Just like you would not necessarily choose a dentist to operate on your spine, you should also not hire just
anyone with a law license. DEA and FBI opioid investigations are not the time to experiment and the federal
justice system will sanction false strategies and ineffective legal advice. A good way to narrow the scope
is to identify those lawyers that limit their practice to healthcare fraud defense cases. Only those
criteria ensure that your lawyer understands the relevant healthcare statutes and, at the same time, offers
you a track record of successful negotiations with the DEA, the FBI, and the Department of Justice. In
general, you should ask the following questions:

  • How much of your practice is dedicated to federal criminal defense?
  • How many healthcare fraud defense cases have you handled?
  • What is the percentage of you avoiding criminal charges in healthcare investigations?
  • What is the percentage of you avoiding a license suspension or criminal liability in DEA opioid
  • Who at your firm will handle my case?

What Are Recent Case Outcomes Nick Achieved for His Clients in DEA/FBI Cases?



The natural tendency for people just to chat and to talk and to share their

  • United States v. Potash et al. (Pharmacy): Federal Judge DISMISSED the Entire
    Healthcare Fraud Case Against Nick’s Client Although All Other Co-Defendants Had to Stay on the Case
    and Even Though Nick’s Client Was Considered the “Ringleader.”
  • DEA Search Warrant (Physician): DEA Alleged Violations of Controlled
    Substances Act. No Civil or Criminal Charges after Nick’s Intervention. No Reporting to Board.
  • DEA Search Warrant (Pharmacy): DEA Alleged Violations of Controlled Substances
    Act. No Civil or Criminal Charges after Nick’s Intervention. No Reporting to Pharmacy Board.
  • DEA Search Warrant (Pharmacy): DEA Alleged Violations of Controlled Substances
    Act. No Civil or Criminal Charges after Nick’s Intervention. No Reporting to Pharmacy Board.
  • DEA Overdose Investigation (Physician): Government Threatened Life Sentence.
    No Civil or Criminal Charges after Nick’s Intervention. No Reporting to Medical Board.
  • Federal Grand Jury Investigation (Physician): DEA and FBI Investigation
    Alleging Prescription Fraud. No Civil or Criminal Charges after Nick’s Intervention. No Reporting to
    Medical Board.
  • Federal Grand Jury Investigation (Physician): DEA Investigation Alleging
    Opioid Abuse, Medically Unnecessary Pain Prescriptions. No Civil or Criminal Charges after Nick’s
    Intervention. No Reporting to Medical Board.
  • Federal Grand Jury Investigation (Physician): DEA Investigation Alleging
    Controlled Substances Act Violations. No Civil or Criminal Charges after Nick’s Intervention. No
    Reporting to Medical Board.
  • Federal Grand Jury Investigation (Physician): FBI Investigation Alleging
    Kickbacks for Prescriptions. No Civil or Criminal Charges after Nick’s Intervention. No Reporting to
    Medical Board.
  • Federal Grand Jury Investigation (Business Owner): DOJ Investigation Alleging
    Kickbacks for Prescriptions. No Civil or Criminal Charges after Nick’s Intervention.
  • Federal Grand Jury Investigation (Healthcare Business): DOJ
    Investigation Alleging Kickbacks for Prescriptions. No Civil or Criminal Charges after Nick’s
  • Please ask Nick for many more examples. Call 888-680-1745 today!

Is My Consultation with Nick Oberheiden Confidential?



Yes, irrespective of your decision to later engage Nick Oberheiden and his team, Nick offers free
consultations that are protected and confidential by law.

How Much Does It Cost to Defend My Case?



The answer to this question depends on the stage your case is in: is it a commercial insurance audit, a
government subpoena, a search warrant, or a criminal indictment? Are you just weeks away from a federal
criminal jury trial or do you just have preventive counseling and compliance questions? Attorney Nick
Oberheiden is happy to speak with you about your specific concerns and to offer you a free and absolutely
confidential consultation. If his track record and his unique approach convince you, Nick will work with you
to tailor the legal representation to your current financial situation. Payment plans and credit card
payments are available in some circumstances.

How Can I Speak to Nick Directly?



The easiest step in the entire process is to get in touch with Nick directly. When you call 888-680-1745,
you will be connected with Nick’s mobile device. Nick does not use secretaries and ALL clients will be
represented by Nick and senior attorneys and never delegated to junior lawyers or paralegals.


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Do You Need Help with Your Case?

Are you under healthcare fraud or opioid investigation? Is your business under audit? Did you receive a notice from insurance companies or the government? Have investigators served you with a Civil Investigative Demand, a grand jury subpoena, an OIG subpoena, or did they try to interview you about a case? Did you experience a DEA or FBI search warrant? If you are seeking answers to pressing legal questions or are looking for effective and reliable help, then call DEA defense attorney Dr. Nick Oberheiden today. Nick will not hand your case to junior lawyers and no secretary will block you off. Call today, 888-680-1745 or contact him online, and get a free and confidential assessment from an experienced healthcare fraud defense attorney.

Put our highly experienced team on your side

Dr. Nick Oberheiden
Dr. Nick Oberheiden



John W. Sellers
John W. Sellers

Former Senior Trial Attorney
U.S. Department of Justice

Local Counsel

Joanne Fine DeLena
Joanne Fine DeLena

Former Assistant U.S. Attorney

Local Counsel

Joe Brown
Joe Brown

Former U.S. Attorney & Former District Attorney

Local Trial & Defense Counsel

Amanda Marshall
Amanda Marshall

Former U.S. Attorney

Local Counsel

Aaron L. Wiley
Aaron L. Wiley

Former Federal Prosecutor

Local Counsel

Roger Bach
Roger Bach

Former Special Agent (OIG)

Michael Koslow
Michael Koslow

Former Supervisory Special Agent (FBI)

Chris Quick
Chris Quick

Former Special Agent (FBI & IRS-CI)

Kevin M. Sheridan
Kevin M. Sheridan

Former Special Agent (FBI)

Ray Yuen
Ray Yuen

Former Supervisory Special Agent (FBI)

Dennis A. Wichern
Dennis A. Wichern

Former Special Agent-in-Charge (DEA)

Legal Disclaimer

Nothing in this document is meant to be legal or medical advice. Prior results do not guarantee similar future outcomes. This document may constitute attorney advertising in some states. All disclaimers on apply.

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