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Justice Department Likely to Target Pain Management “Pill Mills” in 2018

Categories: Health Care Law

opioids pain management

Effective Federal “Pill Mill” Defense Lawyers

With the nation’s opioid crisis continuing to garner headlines, federal prosecutors at the U.S. Department of Justice (DOJ) and other agencies are aggressively targeting those who supply drugs to opioid-dependent individuals. While this includes drug dealers who sell heroin and fentanyl, it also includes physicians and pharmacists who prescribe and distribute opioid medications.

Last year, the DOJ executed a number of high-profile takedowns of so-called “pill mills.” The DOJ defines a pill mill as, “a medical clinic that is dispensing controlled substances inappropriately, unlawfully, and for non-medical reasons.” Some examples of these takedowns include:

  • A physician in Montgomery, Alabama who pleaded guilty to prescribing oxycodone, hydrocodone, methadone, hydromorphone, amphetamine, and fentanyl without medical necessity. According to the DOJ, the doctor would require patients to undergo monthly physical examinations before prescribing them opioid medications, and then would unlawfully bill Medicare, Medicaid, and private insurers for the unnecessary exams and prescriptions. The doctor faced up to 30 years of federal incarceration in addition to, “substantial monetary penalties, restitution, and forfeiture of assets.”
  • Two physicians in Norwalk, Connecticut faced federal charges for allegedly, “provid[ing] prescriptions for narcotics, including oxycodone and hydrocodone, to patients that [they] knew were addicted or had been arrested for distributing or possessing controlled substances.  On numerous occasions, [they] provided prescriptions to patients who paid . . . $100 in cash for each prescription. In certain instances, [they] would write prescriptions for individuals who were not . . . patients in exchange for cash. . . . [They] also regularly provided post-dated prescriptions to individuals, sometimes with dates that matched future dates when the doctors would be out of the country.”
  • A doctor in Tampa, Florida was sentenced to nearly four years in federal prison for his role in an opioid pill mill. According to the DOJ, he would sell oxycodone and other opioid medications to individuals who would then sell the pills, “in the community on a per-pill basis.” In many cases, this involved prescribing medications to individuals he had never examined. All together, he wrote prescriptions for more than 18,000 medically-unnecessary oxycodone pills before he was arrested.

The list goes on and on. With the DOJ’s creation of a new Opioid Fraud and Abuse Detection Unit in August 2017, and the announcement of several new initiatives specifically targeting opioid fraud and abuse in November – family practitioners, clinicians, pharmacists, and others who deal with opioid medications can expect to face even greater federal scrutiny during 2018.

How the DOJ Targets Pill Mills and Health Care Practitioners for Federal Prosecution

For both law-abiding health care practitioners and those who engage in unlawful practices involving opioid medications (whether intentionally or unintentionally), the risk of facing a federal investigation is substantial. Federal authorities are monitoring all medical practices that prescribe and dispense opioid medications, and they often rely on incomplete information when pursuing investigations of suspected pill mills. For example, the DOJ has publicly stated that the following are among the factors that are likely to trigger an investigation for opioid fraud:

  • Opioid prescription rates that exceed those of other physicians
  • Dispensing disproportionately-large amounts of opioid medications
  • Patient deaths within 60 days of receiving an opioid prescription
  • Average age of patients receiving opioid prescriptions
  • Tips from patients and other members of the community who believe that physicians may be illegally distributing opioid medications

As you can see, none of these factors directly correlate to illegal opioid prescription or dispensing practices. There are fully-legitimate reasons for certain physicians to prescribe more medications than others (and for nearby pharmacists to distribute larger numbers of opioids), and patients’ ages and health risks can vary based upon geographic and demographic factors in a particular area. Likewise, few individuals are qualified to assess the legality of physicians’ prescription or billing practices under federal law. Yet, if program billing data suggest an “anomaly,” or if a patient appears to present credible information about a possible illegal prescription, in 2018 this can be enough to force a health care provider to defend itself against “pill mill” allegations.

Consequences of Being Targeted as a Pain Management “Pill Mill”

The consequences of being targeted in a federal investigation can be devastating. With the DOJ’s mandate to use law enforcement to combat opioid fraud and abuse, providers suspected of operating pill mills are facing vigorous investigation and prosecution. And often, the penalties for violating federal controlled substance and health care fraud laws are far greater than most providers suspect. The federal charges typically filed against alleged pill mill operators carry federal prison sentences of 10 to 20 years; and when an unnecessary prescription or diversion of an opioid medication leads to death, the doctor who provided the drug can face life behind bars.

Even when an investigation into a pain management clinic or pharmacy is misguided, the investigation itself can have damaging repercussions. The negative publicity of being labeled a possible pill mill can ruin a practitioner’s reputation; and if not enough is done to intervene in the government’s investigation, a misguided investigation can still lead to federal charges. Being targeted in a federal investigation can have potential licensing implications as well. Without a strategic approach to such events, a manageable situation can quickly get out of control.

If your pain management clinic, family practice, pharmacy, or other medical practice is facing a federal opioid fraud investigation, you need skilled legal representation. The DOJ is devoting its top resources to targeting pill mills and other providers suspected of unlawful practices involving opioids, and protecting yourself against the government requires putting experience on your side. At Oberheiden, P.C., our defense attorneys and former federal health care fraud prosecutors have decades of experience in civil and criminal cases. We can help prevent your investigation from leading to charges; and if necessary, we can fight for your freedom at trial.

Schedule a Free Opioid Fraud Case Assessment with Qualified Federal Defense Attorneys

For more information about the government’s efforts to combat opioid fraud and abuse, please contact us to arrange a free, no-obligation consultation. You can reach us nationwide at (888) 519-4897, or send us your contact information and we will be in touch as soon as possible.

Oberheiden, P.C.
Compliance – Litigation – Defense
This information has been prepared for informational purposes only and does not constitute legal advice. This information may constitute attorney advertising in some jurisdictions. Merely reading this information does not create an attorney-client relationship. Prior results do not guarantee a similar outcome for any matter in the future, every case is different. Oberheiden, P.C. is a Texas LLP with its headquarters in Dallas. Mr. Oberheiden limits his practice to federal law.

Who Will Handle Your Case

When you hire us, you will not work with paralegals or junior lawyers. Each lawyer in our Health Care Practice Group has handled at least one hundred (100) matters in the health care industry. So, when you call, you can expect a lawyer that immediately connects with your concerns and who brings in a wealth of experience and competence. For example, you need someone like Lynette S. Byrd, a former federal prosecutor in health care matters, who recently left the government and who is now sharing the valuable insights she gained as a health care prosecutor with our clients.

Dr. Nick Oberheiden

Dr. Nick

Lynette S. Byrd

Lynette S.