What is a Pill Mill? | Orlando Healthcare Fraud Defense Attorney

What is a Pill Mill?

A pill mill is a type of health care fraud where a clinic or medical office prescribes controlled substances outside the scope of professional practice and without a legitimate medical purpose. Pill mills often prescribe highly addictive opioids like oxycodone to patients without thoroughly examining them or their medical history. The goal of a pill mill is to make money by prescribing as many pills as possible.

Pill mills started popping up in Florida in the early 2000’s and spread across the country over the next decade. By 2011, 98 of the top 100 oxycodone-dispensing physicians in the country were based in Florida. At one point, Florida was supplying much of the illegal oxycodone sold on the black market throughout Appalachia and New England.

In response, Florida and the federal government passed a series of laws and regulations aimed at cracking down on pill mills. The state banned doctors from dispensing controlled substances directly to patients. The Drug Enforcement Administration (DEA) started closely monitoring the production and distribution of prescription opioids. These efforts led many pill mills to shut down.

However, some pill mills adapted by bringing in out-of-state patients and accepting only cash payments. Many also started prescribing different cocktails of controlled substances, like benzodiazepines, muscle relaxers, and stimulants. As law enforcement tries new strategies to combat pill mills, some continue to find ways to skirt the rules and regulations.

How Do Pill Mills Operate?

Pill mills often share certain red flags that set them apart from legitimate medical practices:

• Minimal acceptance of insurance – Most pill mills deal exclusively in cash to avoid scrutiny of insurance companies.
• Limited medical examinations – Patients typically just fill out a short form and undergo a cursory evalutation.
• High volume of patients – Pill mills see dozens of patients a day and prescribe controlled substances to most.
• Aggressive marketing – Many pill mills advertise as “pain clinics” and offer coupons or discounts to lure in customers.
• Out-of-state plates – Pill mills attract “patients” from other states who can’t easily get prescriptions from local doctors.
• Security and queues – Some pill mills have bouncers at the door and lines of patients waiting outside.

In addition to these signs, law enforcement and state health agencies keep close tabs on which clinics and practices prescribe an unusually high amount of controlled substances. However, pill mill operators are constantly finding new ways to avoid attention from regulators.

Legal Implications for Pill Mills

Both pill mill owners/operators and prescribing doctors can face serious criminal charges for their involvement. Charges may include:

• Drug trafficking – Distributing controlled substances without a legitimate medical purpose is drug dealing under the law. Even prescribing drugs via telemedicine to patients the doctor has never met in person can lead to trafficking charges. See U.S. vs. Cynthia Cadet.
• Healthcare fraud – Billing health insurance for unnecessary prescriptions is considered healthcare fraud. Pill mill doctors often commit insurance fraud even when the clinic deals mostly in cash. See U.S. vs. Jesus Lavezaris.
• Money laundering – Pill mills generate huge cash profits that owners must launder into the legitimate financial system. Prosecutors can add money laundering charges if pill mill operators use shell companies or other means to hide assets. See U.S. vs. Moshe Mirilashvili.

These criminal charges can result in lengthy prison sentences and massive fines. The government also may seize assets like bank accounts, vehicles, and real estate connected to pill mill operations. For example, one Florida doctor was sentenced to 17 years and ordered to forfeit $5.2 million in assets from his pill mill business.

Defenses for Pill Mill Allegations

Doctors accused of illegally prescribing medication have several legal defenses they can raise:

• Lack of intent – Prosecutors must prove the doctor knowingly acted without a legitimate medical purpose. Evidence showing the defendant sincerely tried to practice medicine properly can undermine charges.
• Practicing within standards – If other doctors in the region make similar judgment calls in prescribing, it can show the defendant acted within accepted medical standards.
• Record-keeping mistakes – Sloppy or incomplete patient files alone are insufficient to prove unlawful distribution of controlled substances.
• Unnecessary exam was reasonable – The law grants doctors flexibility in deciding whether to physically examine patients or order tests before prescribing.

An experienced health care fraud defense attorney can evaluate the evidence and identify viable defenses to these allegations. In particular, the lack of intent to deal drugs unlawfully is critical. The attorney can retain expert witnesses and gather evidence to show the defendant doctor tried in good faith to treat patients’ conditions.

If you or a health care professional you know is under investigation related to pill mill allegations, immediately consult with a lawyer. An indictment for drug trafficking or health care fraud should not be taken lightly. An attorney can negotiate with prosecutors for a favorable plea deal or build a strong defense for trial. Don’t say anything to investigators without experienced legal counsel.

The lawyers at Bursch Law PLLC have successfully defended health professionals around the country against pill mill allegations and other health care fraud charges. For a free consultation from our Orlando office, contact us today.

Sources

• U.S. Department of Justice: Report Suspected Unlawful Activity
• U.S. Department of Justice: National Health Care Fraud Takedown Results
• CDC: Understanding the Epidemic
• National Institutes of Health: History of Pill Mills
• U.S. vs. Cynthia Cadet
• U.S. vs. Jesus Lavezaris
• U.S. vs. Moshe Mirilashvili
• U.S. vs. Michael Shook