Prescription Fraud by Medical Professionals

Drug trafficking conspiracy cases are commonly prosecuted in federal court, but cases of doctor’s prescriptions for pain medications are not the usual conspiracy to distribute controlled substances. Often the pattern of drug conspiracies reveals local traffickers who are recruited to assist in the chain of distribution from the border of the United States to destinations much farther away. However, “pill mill” cases are prosecuted by the United States Attorney where physicians are accused of providing prescriptions for hydrocodone and other pain medications where there is no medical necessity and not within the usual course of practice. Often these cases are prosecuted in federal court, yet some are prosecuted in the state district courts by the local District Attorney.

Roles and Accusations

The more-common scheme or conspiracy includes a physician, or physicians, often from pain management clinics, who prescribe many prescriptions to patients with a significantly higher amount of pain pills per prescription than normally found within a medical practice. Others who are accused are the doctor’s staff, and possibly a pharmacist or pharmacists. If staff members are accused as part of the conspiracy, the accusations usually are that the staff assisted in scheduling patients for continued visits, knowing that there are very high levels of pain medications being prescribed.

Also, allegations in such a conspiracy can include: mass marketing of the clinic; cash payments required for visits; tests conducted on the patients that are not necessary; diagnosis that are incorrect in order to justify giving the pain medications and at the level prescribed; and false urine test results to also justify the medication levels.

Pharmacists can be charged when: 1) they are filling prescriptions that have no medical value due to the overly high dosage rates; 2) the pharmacist is filling the prescription for someone else, although it is not in that person’s name; 3) the prescription is altered to reflect a higher dosage; and 4) the prescription has been altered in some other manner. If a pharmacist is targeted as a person involved in the conspiracy, he may be filling prescriptions that he knows are not correct dosages.

Charges for Pill Mill Cases

Pill mill cases are frequently charged as federal criminal offenses by the U.S. Attorney’s Office as Conspiracies to Distribute Controlled Substances. Controlled substances charges are in Title 21 of the United States Code. Also, Money Laundering is charged where the proceeds of the physician’s clinics, or of the pharmacies, are used to purchase assets and where the proceeds are deposited into a financial institution or brokerage account. Money Laundering charges are found in Title 18 of the United States Code, Sections 1956 and 1957.

Criminal Indictments

Indictments charging criminal tax evasion or tax fraud sometimes contain forfeiture provisions, as do Indictments for other cases in federal court. A forfeiture provision provides that an order of forfeiture is granted if the defendant(s) are found guilty of the charges, thereby giving the U.S. Attorney’s Office the ability to seize and forfeit property that was purchased, or partially purchased, with illegally obtained monies. Also, these forfeiture orders usually contain a “substitute assets” provision, allowing the U.S. Attorney to seize other assets that the defendant owns that does not have a mortgage or lien, in order to forfeit them for the government’s benefit, with the proceeds of the sale going to the U.S. Department of Justice.

Criminal Investigations for Prescription Drug Related Offenses

Investigations are document intense and include numerous records that the agents compile after: 1) subpoenas are issued and served for bank records and other records, such as records of real estate purchases and other asset acquisitions; 2) search warrant executions of businesses, residences, and safe deposit boxes; 3) a financial analysis of the defendant related to his financial condition and the amount of assets he owns or controls; and 4) records of straw acquisitions by others who may hold assets for the defendant so the does not have certain properties in his name.

Sentencing

Any person convicted of tax evasion, tax fraud or other similar charges in federal courts related to prescription drug fraud is subject to the same type of sentencing as in other federal cases. These sentencings are influenced greatly by the U.S. Sentencing Guidelines, taking into consideration the recommendation punishment range from the calculations of the U.S. Sentencing Guidelines.