14 Florida Physicians Indicted in 'Pill Mill' Bust

August 30, 2011 — Fourteen physicians in southern Florida have been indicted as members of what one agent with the Federal Bureau of Investigation calls "the nation's largest criminal organization" involved in illegally distributing opioid analgesics such as oxycodone.

Thirteen of the physicians, along with 19 other individuals, face federal charges ranging from conspiring to distribute a controlled substance to money laundering. The fourteenth physician, Gerald J. Klein, MD, was charged in a state court on August 18 with, among other things, first-degree murder in the death of a man who overdosed on a massive amount of hydromorphone and alprazolam that Dr. Klein had prescribed, according to authorities.

Dr. Gerald J. Klein

The 14 physicians worked in 4 pain management clinics that the federal indictment, which was made public August 23, depicts as set pieces in a gangster movie. Drug addicts and drug traffickers, most from out-of-state, packed the waiting rooms, and if they were not fighting each other, they were having drug-induced seizures. Security guards tried to maintain order. Opioid analgesics were dispensed and prescribed on an assembly line basis, and were paid for with cash and credit cards. Clinic employees hauled their money to the bank in large garbage bags. During a 2-year period, the clinics raked in more than $40 million from illegal drug sales, a federal grand jury stated.

The physicians prospered in the process, according to the indictment. The owners of the clinics paid most of them according to how many patients they saw, which ranged between 40 and 100 patients per day. The average physician earned more than $1 million a year this way.

The indictment states that the physicians prescribed opioid analgesics without a basis in medical necessity, but engaged in subterfuges to make it look otherwise. Before their visits, for example, patients were routinely directed to a mobile magnetic resonance imaging facility that operated 7 days a week past midnight in a strip club parking lot.

The clinic owners were careful to recruit physicians who supported their business plan, the indictment states. Applicants did not need any experience in pain management, only a willingness to write scripts every 10 minutes. During employment interviews, "the physicians were asked whether they would agree to prescribe large quantities of oxycodone, Xanax, and other controlled substances."

Once hired, physicians would receive instructions from the owners on the quantity of pain meds that a patient should receive. They agreed to not wean patients off high dosages or refer them to detoxification facilities or addiction experts. One unidentified physician told an investigator that the goal was to keep patients "happy."

Pain Clinic Owner a Convicted Felon

The criminal organization described in the federal indictment extended beyond the 4 pain clinics to encompass 2 drug stores, a pharmaceutical wholesaler that supplied clinic physicians with pain medications, the magnetic resonance imaging facility, illegal Internet sales of anabolic steroids, and a fraudulent time share business. Heading the enterprise, the indictment states, were 2 brothers, Jeffrey George and Christopher George, the second of whom has spent time in prison on drug charges. The George brothers also launched a pain clinic in Georgia and may have eyed expanding their operation to the Midwest, according to the indictment.

In the world of South Florida pain clinics, the George brothers played rough, the grand report alleges, directing coconspirators to vandalize competing facilities. The 2 brothers, along with 2 coconspirators, were charged with kidnapping and assaulting a suspected thief.

The federal government built its case against the George brothers and their accomplices in part by recording conversations with one of the physicians and tapping the cell phone of Christopher George.

"The significance of [the] takedown is that we have dismantled the nation's largest criminal organization involved in the illegal distribution of pain killers," said John Gillies, the bureau's special agent in charge of Miami.

Of the 32 defendants, only Christopher George and Steven Goodman, RPh, owner of the pharmaceutical wholesale company, have entered pleas as of today, according to federal court records. Both men have pleaded not guilty.

Criminal Expansion Into Pharmacies

In all, 32 individuals were indicted a federal district court in southern Florida as part of what authorities called Operation Oxy Alley. The US Department of Justice (DOJ) has recently prosecuted pill mills and their physician prescribers in other parts of the country, but the Florida bust ranks near the top in terms of size.

Gary Boggs, a supervisory special agent in the Office of Diversion Control in the US Drug Enforcement Agency, told Medscape Medical News that Florida is the epicenter of "rogue pain clinics."

One possible reason why Florida is such a magnet for pill mills is the state's high proportion of elderly citizens, said David Melenkevitz, a DOJ spokesperson.

"That population would bring about a large medical community — doctors, pharmacies, and hospitals," Melenkevitz told Medscape Medical News. "So there are a lot of medical professions for these drug dealers to corrupt."

The indictment notes that during the time frame of the alleged offenses (from 2006 to March 2010), Florida lacked a prescription drug monitoring program similar to the kind used in other states to detect drug abuse and diversion. Florida passed a law in 2009 authorizing such a program, but the DOJ states on its Web site that as of May 2011, the Florida program was not fully operational.

Another law enacted in 2010 prohibits felons from owning pain management clinics and limits clinics to dispending no more than a 72-hour supply of medications to a patient who pays in cash. The rationale here is that greenbacks are harder for law enforcement agencies to monitor than credit cards. Making it harder for Florida pill mills to dispense pain medications has caused their owners to open pharmacies, noted Gary Boggs.

The George brothers' enterprise included 2 pharmacies, according to the federal indictment.

The DOJ is cracking down on multibranched pill mill operations in other states. Four physicians, 1 psychologist, and 12 pharmacists working together with 26 pharmacies in Michigan were indicted earlier this month on Medicare and Medicaid fraud charges in connection with the illegal distribution of controlled substances.

Holding Physicians Responsible for Overdoses

The bust in South Florida further demonstrates a willingness of law enforcement authorities to hold physicians responsible for overdose deaths caused by their work in pill mills. Several weeks ago, 2 physicians who once practiced in Colorado were indicted in a federal district court of illegal prescribing that led to 4 deaths.

With the alleged pill mill operation in South Florida, a state grand jury went a step further and indicted Dr. Klein for first-degree murder on account of the overdose death of 30-year-old Joseph Bartolucci. Dr. Klein is accused of prescribing Bartolucci, a repeat patient, with 150 8-mg hydromorphone pills, 30 2-mg alprazolam pills, and 30 25-mg nortriptyline pills in 2009. Bartolucci filled the prescriptions for hydromorphone and alprazolam the same day and was found dead the following day, according to the indictment. An autopsy attributed the death to the 2 drugs.

The state grand jury charged Jeffrey George with second-degree felony murder in Bartolucci's death. George, Dr. Klein, and a third person who is also a defendant in the federal case face various drug-trafficking charges as well.

Federal and state authorities are aggressively prosecuting physicians said to be pawns of pill mill operators, but physicians who prescribe opioid analgesics in good faith to their patients have nothing to fear, said Melenkevitz.

"We're not targeting doctors who make a prescribing mistake on a bad day," he said. "We're targeting drug traffickers who are operating outside the scope of regular medicine."

"They're just drug dealers in white coats," added Boggs.