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I. Generally

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, the United States Attorney prosecutes “pill mill” cases 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.

Persons who may be involved or charged for involvement in such a scheme or conspiracy include pharmacists, who knowingly fill prescriptions that are not medically necessary or are above the accepted normal range of medication given to a person.  Also included can be, physician’s assistants, and doctor’s office personnel, if these persons facilitate the patient obtaining pain medication if the patient should not legitimately receive it, or if the patient receives higher doses than is medically necessary.

In these types of cases, sometimes other co-conspirators include recruiters, who recruit persons to go to doctors’ offices as “patients,” claiming that they need pain medication.  When the “patient” receives the prescription or the pills from filling the prescription, the recruiters pays the “patient” a small amount of money for the pain medication obtained.

II. 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’s 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.

III. Charges

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.

IV. Indictments

Indictments charging illegal Distribution of a Controlled Substance can contain forfeiture provisions, as do Indictments for other cases in federal court.  A an order of forfeiture is granted if the defendant is found guilty of the charges, thereby giving the U.S. Attorney’s Office the ability to seize and forfeit property that was purchased with illegally obtained monies.

Forfeiture orders contain a “substitute assets” provision, allowing the U.S. Attorney to seize other assets that the defendant owns in order to forfeit them for the government’s benefit, with the proceeds of the sale going to the U.S. Department of Justice.

V. Investigations

Investigations focus on doctors’ offices records and pharmacy records, including inventory amounts, as well as testimony of persons who claim that a doctor, pharmacist, physician’s assistant, or someone working with them, authorized a prescription for a controlled substance when the person did not qualify for a prescription.

Also, the investigation could focus on legitimate prescriptions that continue to be presented and filled when no authorization was given by the treating doctor. 

VI. Sentencing

Any person convicted in federal court is subject to the same type of sentencing as in other federal cases.  These sentencing 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.

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