Chapman Law Group is dedicated to the defense of all health professionals facing criminal and/or licensing action. We are especially dedicated to the defense of pain management doctors and their pain clinics, as we understand the pressure these doctors often feel from the vast amount of laws and regulations on their practice and the extreme ramifications they face if they fail to comply. In recent years, Federal and State enforcement agencies have drastically expanded their drug task forces, leaving many pain management doctors feeling as though they have a target on their back. Over the last decade, federal and state prosecutors have arrested and charged several thousand doctors with criminal violations related to their prescribing of prescription narcotics. In a number of those cases, the doctors were wrongly charged with criminal offenses. In these cases, either state prosecutors misunderstood the applicable standard or prosecuted what essentially should have only been violations of administrative rules and handled by state licensing boards. While it is possible for these doctors accused of operating a “pill mill” to be exonerated, in many cases significant damage has been done to their professional reputation, practice or career, and licensing suspensions and sanctions have already been put in place.
The reason for such increased attention towards combating prescription narcotics abuse is the result of the “war on prescription drugs” in America. While it cannot be argued that prescription drug abuse has become an epidemic, the line between facilitation of this offense and providing adequate health care is increasingly blurry. Such efforts on the part of the federal government to combat prescription drug abuse have the effect of widening the gap between legitimate patients in chronic pain and their well-meaning pain management doctors.
As the fear of federal prosecutions loom, scrupulous doctors are more likely to turn away patients with chronic pain, leaving these patients to fend for themselves.
Moreover, we are seeing an increasing trend of doctors underprescribing pain medications for fear of being “red flagged” as a “pill mill” by state prescription monitoring systems (e.g. MAPS, E-FORCSE, OARRS, etc).
As Vicodin and other Hydrocodone-containing products become Schedule II narcotics, doctors are sure to face increased scrutiny, heightened criminal exposure, and inflated state and federal sentencing for convictions related to the prescription of narcotics.
Under the federal standard, a doctor is guilty of criminal conduct if he or she prescribes without a “legitimate medical purpose” and outside the “usual course of his professional practice”. If this standard appears shockingly low – you are correct. This standard has the effect of essentially enumerating the standard of care and making departures from the standard of care a potentially criminal offense.
State standards vary widely from making simple departures from the standard of care and state administrative rules criminal, such as in Ohio, to requiring an “intent” to traffic in narcotics as in Michigan. See Unlawful Prescribing.
First and foremost, it is important to understand that the word “audit” is synonymous with investigation. Federal and state narcotics investigators frequently use their administrative powers to force their way into your clinic and monitor your prescribing habits. Very rarely does an investigation start with the police knocking on your door. If the police, DEA or other federal and state investigators have “raided” your practice with a search warrant, you can bet that their investigation is almost at its conclusion.
Therefore, it is imperative that you retain a qualified criminal defense attorney / administrative law attorney to aggressively defend you at the initial stages of an “audit”. This will ensure that you are protecting your rights at every stage of the “audit”, or investigation, and may prevent criminal charges from ever being filed. If you are raided by the DEA, local police, drug task force or other enforcement agency, you should contact an attorney immediately. There are several key things that an experienced criminal defense attorney can help you do in the first 24-48 hours following a raid that may improve your success in defending charges that will likely follow a raid.
Health Care Fraud
Federal investigators use CMS data, state automated prescription systems data collected from health insurers, and other electronically stored data to look for statistical deviations in prescription habits. Once these are found, the state will usually begin an audit and look deeper into your prescription habits to see if you are operating a “pill mill”. From there, state investigators may send undercover agents or informants into your clinic or make contact with existing patients to tighten their web. This investigation will ultimately culminate in the authorization of a “search warrant” and your pain clinic may be “raided”. This will happen with little notice and generally will result in some media coverage alleging that you operate a “pill mill”.
First, be proactive. If you believe you may be investigated by state and/or federal authorities, you should contact an experienced criminal defense attorney immediately and have an independent investigation/audit done of your practice to see what areas can be improved or what your potential criminal exposure is. If you are already being investigated, it is imperative you reach out to an experienced criminal defense attorney immediately. Delaying may substantially interfere with your ability, or your attorney’s ability, to aggressively defend you. Additionally, with the vast state and federal resources allocated to combating prescription drug abuse, it is imperative your criminal defense attorney have time to prepare your defense to the investigation.
Doctors need to understand that investigation for departures from the standard of care starts a very complex process in multiple arenas – not just criminally.
First, doctors may see suspension of their DEA license. While there is an administrative remedy to appeal the DEA suspension, many are caught off-guard by the rapid suspension of their license immediately after allegations of unlawful prescribing/dispensing are levied. Second, doctors may see their CMS privileges suspended or revoked pending criminal charges and/or administrative proceedings. This means that doctors primarily billing Medicare or Medicaid will immediately lose any source of revenue expected from previous billings not already paid by CMS and may face clawback of prior fraudulent billings. Third, doctors may face immediate suspension of their medical license and/or dispensing license. Doctors practicing in multiple states must also be aware that those states will be notified and will likely also take administrative action against their medical license.
A doctor facing a criminal investigation, charges for unlawful dispensing or prescribing, or “pill mill” allegations, will immediately face an administrative battle on three fronts. This is in addition to the criminal complaint or indictment that is likely pending. Sentencing guidelines for what amounts to drug trafficking under state and federal law vary and are heavily determinate upon the individual charged and the circumstances of the particular offense(s). However, even one count of unlawful prescribing is likely to subject a physician to jail time, or at least a very lengthy probationary period, in addition to licensing sanctions.
While some damage may be prevented by an aggressive criminal defense and professional licensing defense, your attorney must be knowledgeable about all of these areas in order to adequately defend your interests. Too often, physicians overlook the complexity of these arenas and hire an attorney only skilled in criminal law. However, an attorney skilled in state and federal criminal law, as well as state and federal administrative law, will be more economical than hiring multiple attorneys, provide better care due to knowledge of the interplay between all arenas, and be prepared to aggressively protect your rights, your livelihood and your freedom.
Our team of experienced criminal defense attorneys and licensing attorneys have significant experience defending physicians and other health professionals from allegations of unlawful prescribing and health fraud. Chapman Law Group offers a comprehensive defense strategy to cover all areas of your potential criminal case, licensing case and compliance issues without the need to seek out the advice of multiple attorneys.
Our criminal defense team includes two former federal prosecutors. Attorney Perkovic has significant experience with criminal health care fraud, while attorney Chapman has significant experience handling drug trafficking cases against physicians. Both attorneys are highly skilled in criminal defense and are dedicated to representing health care providers.
If you are a pain management doctor or pain clinic charged with drug trafficking or prescribing without medical necessity, our criminal defense attorneys can represent you equipped with the knowledge of the pain management guidelines and the standard of care for prescribing various pain medications. If you are accused of drug diversion, our criminal defense attorneys are able to represent you equipped with real world practical knowledge about medication administration and documentation. Additionally, in over twenty-five (25) years of practice in health law, we assembled an extensive team of experts with expertise in nearly every area of medicine. Our experts include board certified pain management doctors, retired DEA drug diversion agents and private investigators. If charged with a particularly complex offense requiring an expert opinion or consultation, we can put our experts to work for you. Put the time-tested experience of an established health law firm to work for you today.