SITUATION: Busting a Pill Mill
Federal prosecutors recently indicted theowner and two employees of a Maryland pain management clinic, alleging it is a “pill mill.” The DEA heavily targets these so-called “pill mills,” defined as any “health care provider’s office, clinic, or health care facility that routinely prescribes and dispenses controlled substances outside the scope of professional practice and without a legitimate medical purpose.” In this case, the government charges that defendants illegally prescribed and dispensed oxycodone. That is, they did it outside the scope of professional practice and without a legitimate medical purpose.
To support these charges, the indictment relies on evidence that:
- clinic owner prescribed oxycodone without a license;
- oxycodone was prescribed to no-show patients;
- clinic employees conducted cursory medical examinations;
- medical records did not corroborate medical need for oxycodone;
- clinic employees increased patient dosages without medical justification; and
- employees falsified urine drug test results for patients receiving oxycodone prescriptions.
Much of the evidence was obtained by undercover agents posing as patients. If proven, these acts are serious violations of the Controlled Substances Act (CSA). Severe penalties follow for anyone that violates these laws.
STATE OF THE INDUSTRY: Pill Mills and Healthcare Laws
The DEA continues to make headlines by raiding health care businesses including pain management clinics. It also continues to go after individual physicians and other healthcare professionals who illegally prescribe opioids. The DEA’s aggressive efforts to combat the opioid epidemic are poised to continue. Thus, healthcare providers dealing with controlled substances (e.g., doctors, physicians, physicians’ assistants, nurses, pharmacists) face significant risks of investigation and prosecution. Unfortunately, this trend is unlikely to end any time soon.
The stakes have never been higher. Law enforcement has a zero tolerance for any business or individual facilitating the illegal distribution of prescription pain medications like oxycodone. Penalties will likely result in the loss of liberty. Importantly, doctors and other healthcare professionals even face the loss of their DEA licenses, which severely hampers their ability to practice medicine.
BACKGROUND & ANALYSIS: Pill Mill and Controlled Substances
This Case Study profiles a small Maryland pain management clinic owned by Joyce S. Edwards. It also involves two nurse practitioners Edwards employed: Thomas C. Johnson and Justina Aburime. A federal grand jury charged all three individuals with one count of conspiracy to distribute oxycodone to patients without medical need. Oxycodone is a highly addictive narcotic subject to regulation under the CSA. The indictment also charged each individual with distributing and dispensing oxycodone in violation of CSA.
According to the DEA, these defendants operated a “pill mill.” Pill mills are seemingly legitimate pain management clinics that regularly prescribe painkillers without any prior medical history, diagnosis, or documentation. According to the indictment, Johnson and Aburime are certified nurse practitioners. As licensed healthcare professionals, they could legally prescribe and dispense oxycodone and other controlled substances.
Owner Edwards, in contrast, has never been a medical doctor or a certified nurse practitioner. Thus, Edwards lacked the appropriate credentials to legally dispense controlled substances. The government claims Edwards prescribed oxycodone without a license and misrepresented herself as a nurse practitioner; when people misrepresent credentials, they expose themselves to problems with both civil and criminal law enforcement agencies. Also, Edwards routinely used blank oxycodone prescriptions pre-signed by Johnson and Aburime, also in violation of the CSA.
If the case goes to trial, prosecutors will present facts in an effort to persuade a jury or a judge to convict the defendants. If the case proceeds to a jury trial, prosecutors will present evidence to show that:
- Edwards prescribed oxycodone despite not having a license to prescribe medicine;
- that clinic employees’ medical examinations were cursory and incomplete;
- that the medical records did not support the need for treatment with oxycodone;
- that clinic employees increased patients’ dosages without medical justification;
- that employees falsified urine drug test results to make it easier to prescribe oxycodone.
Undercover agents who posed as patients to gather evidence of the defendants’ business practices would likely to testify at trial. (Defendants have the choice to enter into a plea agreement with the prosecution and avoid going to trial.)
Edwards, Johnson and Aburime face the prospect of up to 40 years in prison, significant legal fees, and hefty fines and penalties. If convicted, a federal judge will consider findings in a presentence investigation report, and also the federal sentencing guidelines. The federal sentencing guidelines are not mandatory, but judges must use those guidelines as a starting point. Prosecutors may authorize or recommend lower prison sentences if the defendants cooperate. If convicted, Edwards’ pain management clinic will not reopen for business. Further, Johnson and Aburrime will likely lose their licenses to prescribe controlled substances under the CSA.
RECOMMENDATIONS: Healthcare and Compliance
This Case Study highlights the DEA’s zero tolerance policy towards businesses or individuals that facilitate the illegal distribution of controlled substances like oxycodone. For any person that violates the law, significant personal and financial consequences follow. Loss of personal freedom, time with family and financial resources represent part of the sanction. Collateral consequences also follow, such as lost earning power in the job market.
If facing any type of government investigation or prosecution, defendants should learn more about options, and consider crafting a mitigation strategy to help stakeholders understand more about their intentions, their character, and efforts to make things right.
Our team at Compliance Mitigation, of course, wants to help people avoid government investigations in the first place. For that reason, we recommend that all business owners coordinate a risk assessment of the business, and then create compliance training programs to help.