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It’s no secret that in recent years the opioid prescription drug epidemic has increased. With an increased number of opioid-related overdoses from prescriptions and illicit street drugs, the government is cracking down on everyone. This intervention is cracking down especially on pain management doctors and pain clinics. Due to the very nature of the profession, many doctors are finding themselves on the receiving end of prescription fraud lawsuits and civil lawsuits for injured parties. This article will review some of the triggers that prompt government cases and the effects they have on pain clinics and prescribers of pain medicine.
Under the direction of Attorney General Jeffrey Sessions, “the largest health care fraud takedown in American history” was announced. The takedown included many arrests, exclusion from governmental insurance programs like Medicaid and Medicare, fraud and pharmacy fraud-related charges. It has been estimated that the takedown has saved taxpayers approximately $1.3 billion. Sessions also indicated that he intends on continuing with increased measures to fight the epidemic.
To continue his campaign against opioid and pharmacy fraud, Attorney General Sessions also started the Opioid Fraud and Abuse Detection Unit. The unit operates under the DOJ and monitors data that alerts the unit to potential dangers of pharmacy fraud. Among these dangers include:
| Monitored Activity | What It Means |
|---|---|
| Opioid related drug diversion | Prescriptions being diverted from legitimate medical use to illegal distribution |
| Physician shopping | Patients visiting multiple doctors to obtain multiple prescriptions |
| Kickbacks and incentives monitoring | Financial arrangements that influence prescribing decisions |
| Illegal drug dispensing practices | Prescribing or dispensing controlled substances outside legal guidelines |
In addition to monitoring, the enforcement agency has assigned special federal prosecutors to 12 areas identified as having disproportionately high rates of opioid abuse. The unit will combine forces with the DEA, FBI, HHS, and local and state law enforcement agencies. Those monitoring prescriber practices are also ordered to look for clues indicating the following:
| Red Flag | Why It Triggers Investigation |
|---|---|
| Higher than average opioid scripts written | Suggests potential over-prescribing or drug diversion |
| Opioid related deaths within 60-days | Links prescriber to patient deaths from overdose |
| Patient demographics including ages of patients receiving opioid scripts | Unusual patient profiles may indicate physician shopping or fraud |
| Other prescribing practices that are indicative of pharmacy fraud and abuse | Patterns that deviate from standard medical practice |
As previously mentioned, stiff sentencing guidelines and civil penalties are at stake from prescription drug fraud. Depending on the severity of the circumstances, many prescribers could face from 10 to 20 years in prison with a maximum penalty of a life sentence. Hefty civil lawsuits are also common when a prescriber’s negligence is the result of serious injury or death. The loss of credentials, licensing, and income is also likely even if a prison sentence isn’t imposed. The loss of credibility and credentials in the medical field can also affect one’s future when attempting to obtain other employment. Family and relationship strains are almost a certainty as well.
| Type of Penalty | Potential Consequences |
|---|---|
| Criminal Penalties | 10 to 20 years in prison; maximum penalty of life sentence |
| Civil Lawsuits | Hefty damages for serious injury or death caused by negligent prescribing |
| Professional Consequences | Loss of medical license, DEA registration, and credentials |
| Financial Impact | Loss of income, legal fees, fines, and restitution payments |
| Insurance Exclusion | Exclusion from Medicaid and Medicare programs |
| Personal Impact | Damaged reputation, strained family relationships, difficulty obtaining future employment |
If you’ve been notified by the Opioid Fraud and Abuse Detection Unit or any other agency of law enforcement, you need immediate representation. If you have a strong suspicion that an investigation may be underway, it’s also time to contact a competent attorney that has federal case experience. Many clients can walk away unscathed with a solid legal defense and our expertise. It’s strongly inadvisable to speak with law enforcement until represented in these matters. Representing yourself in court is never a good idea. With such a complex area of the law involving many components, you’ll need an experienced attorney on your side. Get in touch with our law office for a case review. We’ll give you some insight and will get to work on your case by building a defense strategy and fighting for your rights.
With the Department of Justice’s aggressive stance on opioid abuse, pain management doctors and pain clinic operators must be especially vigilant. Understanding the warning signs that trigger investigations and the severe penalties at stake is crucial for protecting your practice and your freedom.
| Don’t Do This | Why It’s Dangerous |
|---|---|
| Don’t speak to law enforcement without an attorney | Anything you say can and will be used against you in court |
| Don’t represent yourself in court | Federal cases are complex; you need experienced legal counsel |
| Don’t destroy or alter records | Obstruction of justice can lead to additional charges |
| Don’t ignore warnings or notifications | Early intervention can prevent charges or reduce penalties |
| Don’t continue questionable practices | Ongoing violations worsen your legal position |
The Opioid Fraud and Abuse Detection Unit uses sophisticated data analysis to identify prescribing patterns that deviate from the norm. By monitoring specific red flags and working in coordination with multiple federal agencies including the DEA, FBI, and HHS, the government has unprecedented ability to track and investigate pain management doctors. The collaboration between federal, state, and local law enforcement means that investigations can move quickly and result in serious charges.
With the opioid prescription drug epidemic claiming thousands of lives annually, the government’s response has been swift and severe. The “largest health care fraud takedown in American history” demonstrates the government’s commitment to prosecuting prescription fraud aggressively. For pain clinic operators and prescribers, this means that even unintentional violations or honest mistakes can result in devastating criminal and civil penalties.
Federal criminal cases involving prescription drug fraud and pharmacy fraud are vastly different from state criminal matters. The resources available to federal prosecutors, the complexity of federal sentencing guidelines, and the severity of potential penalties all require an attorney with specific federal case experience. Our law office has successfully defended pain management doctors and pain clinic operators against these serious charges, and we understand the strategies needed to protect your rights, your practice, and your freedom.
If you’re a pain management doctor or operate a pain clinic, don’t wait until you’re facing charges to seek legal counsel. Whether you’ve been contacted by the Opioid Fraud and Abuse Detection Unit, are under investigation, or simply want to ensure your prescribing practices comply with current regulations, we can help. Contact our law office today for a comprehensive case review and let us build a defense strategy that protects your medical career and your future.

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