How Authorities Are Dismantling Pill Mills in the United States

Investigation Reports. The wide availability of prescription opioid pain relievers has led to high levels of abuse. Federal and State officials focus on criminal organizations involved in the illegal distribution of pain pills. Many of these investigations stem from business operations of what was, in essence, a ‘pill mill’ rather than a pain clinic or medical practice focused on pain management.

According to the National Drug Intelligence Center, an estimated 7,500 pill mills operate in the United States. A pill mill is a type of business that prescribes narcotic medications in more significant numbers than would be prescribed in regular physician offices. State and local investigators came up with the name “pill mills.”

Rogue pain management clinics (pill mills) are a significant source of pain pills available to abusers. Investigations indicate that pill mill operations exhibit several unique characteristics, such as the ability of operators to relocate quickly, nearly exclusive associations with specific physicians and pharmacies, primarily cash-based payment methods, and rapid examinations.

Owners of pill mills have established many cash-only operations that are frequently used by distributors. Moreover, many of these out-of-state distributors and abusers work in teams. These individuals or teams frequently follow a route that traverses the eastern, southern, and western regions before returning north. Some arrange shipments to other states through parcel delivery services.

Pill mill operators continually devise methods to subvert regulations and investigations while attracting patients. For example, law enforcement or regulatory investigations have closed pill mills and suspended the licenses of the associated physicians only to have the owners reopen the business at a new location staffed by other licensed physicians. In addition, physicians are increasingly opening pill mills disguised as wellness centers, functional medicine clinics, and urgent care centers. Moreover, pill mill operators increasingly establish proprietary relationships with magnetic resonance imaging services and pharmacies. The DEA reports that applications for new pharmacies increased in 2010. Many of the new pharmacies are being established by former pill mill owners seeking to profit as they did while operating pain management clinics.

Arlington, Virginia. Jury Convicts Doctor in Oxycodone Distribution Operation (Alex Bridges, The Northern Virginia Daily, December 18, 2023)

Federal prosecutors accused Dr. Kirsten Van Steenberg-Ball, 69, of issuing illegal prescriptions for more than 1 million oxycodone pills. Ball, a primary care physician, operated a medical practice out of her Arlington home. Ball ran the drug distribution for more than a decade through a network of people posing as patients to whom she illegally prescribed oxycodone pills, according to the prosecution’s evidence. 

The doctor’s office manager, Candie Marie Calix, of Front Royal, was sentenced to seven years in prison for conspiring to distribute oxycodone. Court records show that Ball prescribed Calix, also a patient, approximately 50,000 oxycodone pills over about 10 years.

The Virginia Department of Health Professions investigated Ball in 2014, 2015, and 2021 for excessive and improper prescribing of oxycodone. Ball falsified records that she submitted to the department to cover up the fact she prescribed the drug to patients for no legitimate reason and outside the course of professional practice, according to evidence prosecutors presented at trial.

Evidence also revealed that Calix, at Ball’s direction, recruited other people, including several immediate family members, to become patients so the doctor could prescribe similarly large amounts of oxycodone to them. Calix then sold the tens of thousands of pills that Ball had prescribed. The prosecution also presented evidence to show that Ball prescribed oxycodone to drug traffickers and drug addicts in exchange for hundreds of dollars. Several patients became addicted to oxycodone.

If you are aware of controlled substance violations in your community, you can submit your anonymous tip through the DEA online Tip Line

As the fight against the opioid crisis continues, State and Federal Authorities are working to shut down phony Pain Clinics that are really just fronts for criminals who divert pharmaceutical drugs and hook a new generation of people with an addiction.

Texas: Clinic Office Manager Sentenced for $1.2M Pill Mill Scheme (December 12, 2023)

A medical clinic office manager was sentenced to seven years in prison for operating a pill mill clinic that unlawfully distributed over 600,000 opioid pills in exchange for cash.

According to court documents and evidence presented at trial, Andres Martinez Jr., 30, of Laredo, Texas, was the office manager of Jomori Health and Wellness (Jomori), a purported Houston pain management clinic. Martinez operated Jomori with Dr. Oscar Lightner, 74, as a pill mill. Lightner, who was the owner of and physician at Jomori, unlawfully prescribed dangerous combinations of controlled substances — including hydrocodone, carisoprodol, and alprazolam — to his patients without a legitimate medical purpose in exchange for cash payments ranging from $250 to $500. Martinez, who is Lightner’s stepson, coordinated with crew leaders to bring multiple people, including individuals living in homeless shelters, into Jomori to pose as patients to obtain prescriptions for opioids and other controlled substances. Jomori received over $1.2 million in cash over 14 months through its scheme, which resulted in the unlawful distribution and dispensing of over 600,000 opioids and other controlled substances.

Martinez and Lightner were convicted of unlawfully distributing and dispensing controlled substances and conspiracy. The DEA investigated the case.

The Dangers of Pill Mills

Pill mills are extremely dangerous because they make it easy for people to abuse opioids. Opioids are a type of drug that is highly addictive and can be very harmful, even deadly, when misused. People who get opioids from a pill mill are more likely to misuse them because they don’t have to go through the proper channels to get the drugs. This means that more people are at risk of developing an addiction to opioids, and more people are likely to overdose on these drugs. Pill mills also contribute to the overall opioid epidemic because they make it easy for people to get their hands on these drugs. Pill mills are often located in areas with a lot of poverty, and people may not have the money to pay for legitimate medical care. They’re likelier to turn to pill mills to get their needed drugs.

Brevard, Florida Doctor Became Known as “The Pill Man” (John A. Torres, Florida Today, November 30, 2023)

Ten people fell victim to a Brevard County doctor who, back in the early 2000s, ran one of the nation’s most active pill mills out of an unassuming office in unincorporated Indialantic.

Atlanta Doctor and Houston Clinic Owner Sentenced to Prison for $5 Million Pill Mill Scheme (FOX 5 Atlanta Staff Writers, November 17, 2023)

ATLANTA, GEORGIA. Dr. Jonathan Rosenfield, 40, and clinic owner Elmer Taylor, 44, of Houston, received sentences of 10 and 12 years in prison, respectively, after pleading guilty to conspiracy charges related to the unlawful distribution and dispensing of controlled substances.

Court documents revealed that Dr. Rosenfield owned, operated, and served as a physician at two Sunnyside Medical pill-mill clinics, operating under the name Sunnyside Wellness. Taylor was a co-owner and co-operator of the clinics. The duo, along with accomplices, issued prescriptions for opioids, including approximately 752,000 pills of oxycodone and 419,000 pills of hydrocodone, using Rosenfield’s name. These prescriptions were not in the usual course of professional practice and lacked a legitimate medical purpose. Individuals paid by drug dealers were often used as fake patients, and the pills were diverted to the illegal market. Between May 2018 and August 2019, the Sunnyside Medical clinics generated approximately $5,478,000 from selling these prescription drugs.

Owner of Lafollette Wellness Center Sentenced for Her Role in Operating a Pill Mill (U.S. Attorney’s Office, Eastern District of Tennessee, November 2023)

KNOXVILLE, TENNESSEE– According to court documents, Sharon Naylor, a Nurse Practitioner, owned and managed a non-insurance, cash-equivalent Pain Clinic named Lafollette Wellness Center, in Campbell County, Tennessee. Naylor continued to own and operate LWC, despite knowing that the Medical Director, Co-Defendant Dr. Henry Babenco, and the physician’s assistant, co-defendant Alicia Taylor, were prescribing opioids to patients outside professional practice and for no legitimate medical purpose. 

On November 2, 2023, Sharon Naylor, 58, was sentenced to a term of imprisonment of 12 months by the Honorable Thomas A. Varlan, United States District Judge, in the United States District Court for the Eastern District of Tennessee at Knoxville. 

As part of the plea agreement filed with the court, Naylor waived an indictment by a Federal Grand Jury and agreed to plead guilty to an information charging her with one count of maintaining a drug premises. Naylor also pleaded guilty to an indictment charging her with one count of money laundering. Naylor was also ordered to forfeit the proceeds of her crime, including approximately $1.9 million in real property, cash, gold and silver coins and bouillon, all of which were seized by the United States.   

Naylor, Dr. Babenco, Taylor, and LWC office manager, Gregory Madron, were charged with drug-related offenses as part of the April 2019 Appalachian Regional Prescription Opioid Strike Force Surge; Taylor pleaded guilty to her role in the distribution of controlled substances in May 2021, Madron pleaded guilty to a misdemeanor offense for his role in September 2023.  Babenco died in a plane crash in February 2021.  Madron and Taylor are scheduled to be sentenced in January and February 2024, respectively. 

U.S. Attorney Francis. M. Hamilton III, of the Eastern District of Tennessee; Special Agent in Charge J. Todd Scott, of the Drug Enforcement Administration (DEA); and Special Agent in Charge Joseph E. Carrico, of the Federal Bureau of Investigation (FBI), made the announcement. 

The charges were the result of an investigation by the DEA, the FBI, the Tennessee Bureau of Investigation, and assisted by the Appalachian Regional Prescription Opioid Task Force.   

WFAA Investigates: Undercover DEA Video Shows North Texas Pill Mill in Action (YouTube Video).

A North Texas Physician was sentenced to prison for trafficking painkillers out of his clinic. Investigators say the case is a roadmap on how to prosecute bad doctors.

Baltimore, Maryland: Medical Director of Baltimore County Pain Management Clinic Pleads Guilty to Conspiracy to Distribute and Dispense Oxycodone (U.S. Attorney’s Office, District of Maryland, June 16, 2022)

Norman Rosen, age 84, of Towson, Maryland, pleaded guilty to conspiracy to distribute and dispense oxycodone in connection with his operation of Rosen-Hoffberg Rehabilitation and Pain Management Associates, P.A., where he was Medical Director and part owner.    

The guilty plea was announced by United States Attorney for the District of Maryland Erek L. Barron; Special Agent in Charge Thomas J. Sobocinski of the Federal Bureau of Investigation, Baltimore Field Office; Special Agent in Charge Jarod Forget of the Drug Enforcement Administration, Washington Division; Special Agent in Charge Maureen Dixon, Office of Investigations, Office of Inspector General of the Department of Health and Human Services (HHS-OIG); and Chief Melissa R. Hyatt of the Baltimore County Police Department.

According to his guilty plea, Norman Rosen is a doctor licensed to practice medicine in Maryland.  He served as the Medical Director and part-owner of Rosen-Hoffberg Rehabilitation and Pain Management.  Rosen primarily worked at the Towson, Maryland locations.  Rosen’s partner in the business and the Practice’s Associate Medical Director was Howard Hoffberg. 

According to Rosen’s guilty plea, patients were often prescribed high doses of oxycodone, and other opioid medications.  Some patients were issued prescriptions for opioids after routinely providing aberrant urine toxicology screens, including positive results for cocaine, heroin, and other street drugs; positive results for controlled substances that were not prescribed by the Practice (which indicated the patient was likely buying medications off the street or was doctor-shopping); and/or negative results for the controlled substances prescribed by the Practice (which indicated prescribed substances were either not taken, being consumed too quickly, or sold by the patients).

Rosen knew that the Practice received complaints about the behavior of patients, including reports of suspected drug transactions in the parking lots near the Practice.  At times, patients were observed “nodding out” in the waiting area.  Some patients tried to bring in urine that was not theirs in order to pass urine toxicology screens.  Some patients overdosed, some of these patients required hospitalization, and some died.

Several major pharmacies refused to fill any prescriptions issued by the Practice because of the high doses being prescribed.  Both Rosen and Hoffberg were aware of the conditions at the Practice and yet continued to prescribe medications to these patients.

As detailed in his plea agreement, as the Medical Director, Dr. Rosen established the rules for the Practice.  One of his rules was that the customer, i.e., the patient, is always right.  Sometimes, when other providers at the Practice discharged certain patients, Rosen continued to treat the patients at the Towson location.  At times, if a patient failed a urine toxicology screen because of illicit substances in their system, such as heroin or cocaine, Rosen declined to discharge the patient and instead required the patient to return to the Practice more frequently for follow-up, sometimes as much as three times a week.

Rosen admitted that he issued prescriptions to some patients outside the bounds of the usual medical practice and not for a legitimate medical purpose.  For example, Rosen prescribed large doses of oxycodone and clonazepam to a patient who had eight toxicology screens that were positive for cocaine and whose children had been taken from her because of her drug problems.  Similarly, Rosen ignored the red flags and prescribed oxycodone and methadone to a patient who admitted to illicit drug use, had previously been criminally charged for prescription fraud and drug trafficking, had overdosed, had urine toxicology screens that were positive for heroin, cocaine, and marijuana; and had been accused of selling her pills.

Rosen faced a maximum of 20 years in prison.  In related cases, Rosen’s partner, Howard Hoffberg, age 65, of Reisterstown, Maryland, pleaded guilty to conspiracy to violate the anti-kickback statutes in connection with a scheme to accept payments from a pharmaceutical company in exchange for prescribing a fentanyl-based drug.  He was sentenced to eight months in federal prison.  Also, a physician’s assistant, William Soyke, age 69, of Hanover, Pennsylvania, pleaded guilty to conspiracy to distribute and dispense oxycodone, fentanyl, methadone, and alprazolam and was sentenced to 37 months in federal prison.

United States Attorney Erek L. Barron commended the FBI, the DEA, HHS-OIG, and the Baltimore County Police Department for their work in the investigation.

Former Pain Management Clinic Owner Sentenced to Over 16 Years for Unlawful Opioid Distribution (April 6, 2022)

According to court documents, Habib Geagea Palacios, 40, of Miami, Florida owned General Care Center Inc., a cash-only pain management clinic in Miami. At General Care, Palacios paid doctors to prescribe opioids to nearly all patients who visited the clinic, resulting in the illegal distribution of more than three million oxycodone pills and generating $9 million in cash. Seven doctors who worked at General Care were charged in connection with their unlawful prescribing practices at the clinic, and six pled guilty.    

Palacios pleaded guilty to one count of conspiracy to distribute a controlled substance and one count of distributing a controlled substance. In addition to the term of imprisonment, Palacios was sentenced to serve three years of supervised release. 

Philadelphia: Chester County Doctor Pleads Guilty to Operating Pill Mill out of Main Line Pain Clinic (U.S. Attorney’s Office, Eastern District of Pennsylvania, February 3, 2022)

Yutong Zhang, 63, of Berwyn, PA, a physician, pleaded guilty before United States District Court Judge Michael M. Baylson to charges stemming from his operation of what was, in essence, a ‘pill mill’ rather than a medical practice focused on pain management located in St Davids, PA.

According to court documents, Dr. Yutong Zhang, 63, of Berwyn, PA, pleaded guilty to four counts of distributing oxycodone-containing medications outside of the usual course of professional practice and for no legitimate medical purpose. From approximately 2016 through 2020, Zhang sold medically unnecessary prescriptions for oxycodone and other controlled substances to about 120 so-called patients, who were cash-paying customers. Zhang supplied these prescriptions frequently after conducting a cursory physical examination or without any examination at all and did not take steps, such as ordering diagnostic testing, designed to discern the root cause of the pain reportedly suffered by patients.

“The U.S. Attorney’s Office is committed to stopping drug-dealing doctors like Zhang,” said U.S. Attorney Williams. “As a physician, he was well aware of the inherently dangerous nature of the drugs he was selling. But because of his greed, he took advantage of vulnerable people struggling with addiction, piling on to the enormous opioid epidemic ravaging the communities in our District.”

“Medical practitioners are trusted to care for our health needs,” said Special Agent Jacqueline Maguire. “When they exploit their position and betray their license to line their own pockets, they not only corrupt the system, they contribute to the very epidemic we are trying so hard to fight. This defendant’s actions were akin to those of a drug dealer; the only difference is, he peddled his poison from an office instead of a street corner.”

“Dr. Zhang abused his position of trust and authority to run a pill mill and illegally prescribe the medications that are fueling the opioid crisis here in Pennsylvania,” said Pennsylvania Attorney General Josh Shapiro. “We are grateful for our partners in this case, and we will continue to work together to stop the flow of illegal drugs into our communities, which take the lives of 14 Pennsylvanians every day.”

The case was investigated by the Radnor Police Department, the Pennsylvania Office of the Attorney General, and the Federal Bureau of Investigation.

Operators of Three Texas Pharmacies and Two Pain Clinics Arrested for Illegally Dispensing Nearly Four Million Opioid Pills (December 2021)

Three Houston-area pharmacists, a doctor, and a pharmacy technician were arrested for allegedly running three pharmacies and two clinics as “pill mills,” distributing hydrocodone, oxycodone, and other controlled drugs without a legitimate medical purpose.

According to court documents, since January 2018, Chrisco Pharmacy (Chrisco), Keystone Pharmacy (Keystone), and Peoples Pharmacy (Peoples) illegally dispensed nearly four million pills of the Schedule II opioids hydrocodone and oxycodone. Keystone owner and pharmacist-in-charge Anthony Obute, 46, of Houston, was indicted for illegally distributing and dispensing hydrocodone and the Schedule IV muscle relaxer carisoprodol. According to the filed criminal complaint leading to Obute’s arrest, Obute operated Keystone as a pill mill, illegally distributing hydrocodone and oxycodone. The complaint further alleges that from about September 2018 to about September 2020, Obute directed Keystone to purchase around 1.1 million of the highest-strength, short-acting hydrocodone, and oxycodone pills commercially available, which he then sold to so-called “crew leaders,” or drug traffickers who pay individuals to pose as patients to obtain pills to sell onto the black market.

Wisconsin: Pain Clinic Owners Sentenced to Federal Prison for Illegal Opioid Prescribing (December 2021)

Lisa Hofschulz and Robert Hofschulz were the owners and operators of Clinical Pain Consultants (“CPC”), which operated in Wauwatosa, Wisconsin.  Following a 9-day trial in August 2021, a federal jury found Lisa Hofschulz guilty of unlawfully distributing Oxycodone, Methadone, and other opioids outside of a professional medical practice and not for a legitimate medical purpose.  The jury also found that Lisa Hofschulz’s unlawful distribution of controlled substances resulted in the death of at least one patient.  The jury found Robert Hofschulz guilty of conspiracy to distribute controlled substances and unlawful distribution of controlled substances. 

The evidence presented at trial established that Lisa and Robert Hofschulz ran CPC as a “pill mill” through which they distributed millions of opioids and other controlled substances throughout 2015 and 2016. The evidence showed that Lisa Hofschulz prescribed opioids and other dangerous controlled substances to 99% of patients, each of whom paid $200 in cash per month for their prescriptions.

The evidence also established that Lisa and Robert Hofschulz distributed controlled substances outside the usual course of professional practice and not for a legitimate medical purpose, including mailing prescriptions to favored patients and prescribing to customers who were not seen by a medical provider. For at least one patient, Lisa Hofschulz’s prescriptions resulted in death. According to the trial evidence, during 2015 and 2016, Lisa Hofschulz was the number one prescriber of oxycodone and methadone in Wisconsin, as compared to all Medicaid providers.

“The opioid crisis continues to disrupt lives and cause injuries and overdose deaths throughout Wisconsin,” said Acting United States Attorney Frohling.  “For many, the road to opioid addiction began with prescription drugs like the ones that CPC and the Hofschulzes willingly provided in exchange for cash.  The Justice Department remains committed to holding accountable individuals who abuse their prescribing privileges to enrich themselves without regard to the damage done to their patients and their communities.”

“With nearly 100,000 Americans dying each year due to opioid overdose, medical professionals who violate their oaths to do no harm must be fully held accountable,” said John G. McGarry, Assistant Special Agent in Charge for U.S. Drug Enforcement Administration-Wisconsin.

46 Convicted in $18 Million Pill Mill Scheme in Fort Worth, Texas (March 2021)

Nassau Doctor Charged with Five Counts of Murder for Depraved Prescription Abuse (Drug Enforcement Administration, March, 2021)

“This doctor’s prescription pad was as lethal as any murder weapon,” DA Singas said. “We allege that Dr. Blatti showed depraved indifference to human life, total disregarded for the law, his ethical obligations, and the pleas of his patients and their family members when he prescribed massive quantities of dangerous drugs to victims in the throes of addiction, ultimately killing five patients who entrusted him with their care. As we continue to battle the epidemic of opioid abuse that has ravaged our communities, this prosecution sends a strong message to any doctor seeking to profit from vulnerable patients’ addiction: we will hold you accountable to the greatest extent the law allows.”

Nassau County doctor was arraigned on five counts of murder for prescription practices that led to the death of five patients between 2016 and 2018.

According to the superseding indictment, Geraldine Sabatasso began seeing Blatti in 2007 for acute pain following an earlier neck surgery. According to records, Blatti was aware that his patient smoked and suffered from chronic obstructive pulmonary disease (COPD) dating back to 2008. Beginning in 2010, the defendant allegedly prescribed Sabatasso opioids and continued to prescribe opioids until her death. In February 2016, the victim fell and complained of dizziness and difficulty walking a straight line, and on March 15, 2016, she complained of shortness of breath and feeling weak– clear signs of opioid addiction. Despite presenting these serious symptoms, Blatti prescribed more clonazepam and oxycodone, and tragically, Ms. Sabatasso died seven days later at the age of 50 of acute oxycodone intoxication on March 22, 2016. It is well established that this combination of opioids and benzodiazepines can have potentially fatal consequences for people with decreased breathing capacity.

George Blatti, 75, was arraigned before Judge Fran Ricigliano on five counts of murder in the second-degree (an A-I) felony and 11 counts of reckless endangerment in the first-degree (a D felony).

The Nassau County Police Department’s Asset Forfeiture and Intelligence Unit began an investigation into several opioid overdoses, both fatal and non-fatal, in August 2018. That investigation revealed that certain individuals had an inordinate number of prescriptions for opioids written by the same physician, Dr. George Blatti. At that time, NCPD began working jointly with members of the DEA’s Long Island District Office (LIDO) Tactical Diversion Squad (TDS).

Blatti, a general practitioner originally licensed to practice medicine in 1976, had no specialized training or accreditation in pain management. For a time, he maintained a makeshift office in a Franklin Square storefront that was formerly a Radio Shack, with a Radio Shack sign and merchandise racks on the walls.

The original indictment alleges that Blatti met customers at his Franklin Square office through 2019, and after he lost access to that space, saw patients in his car, prescribing medications with no examination from the parking lots of the Rockville Centre hotel where he lived and a nearby Dunkin’ Donuts.

The grand jury charged that patients who were addicted to opioids went to Blatti with their requests for controlled medications, and the defendant allegedly prescribed drugs with no medical history review or exam. He billed insurance and accepted cash. In some cases, he allegedly prescribed opioid painkillers at patients’ request to individuals he had never met or spoken to. Blatti used paper prescriptions pursuant to a waiver issued by the New York State Health Commissioner. This allowed him to avoid using the state’s secure electronic prescription system, which is generally required, and provides for greater oversight.

“This is a tragic story of lives lost at the hands of someone entrusted to save lives,” DEA SAC Ray Donovan said. “This defendant’s alleged conduct was unconscionable. Our fight against the opioid epidemic continues, as evident in this case.

3 Sentenced for Prescribing Massive Quantities of Opioids from Pill Mills in Knoxville—The Pill Mills Generated over $21 Million in Revenue, with a Corresponding Street Value of $360 Million (WBIR Staff, December 11, 2020).

Pain Clinic Owner Sentenced for Role in Operating Pill Mills in Tennessee and Florida (October, 2020)

Sylvia Hofstetter, 56, of Miami, Florida, was sentenced by U.S. District Judge Thomas A. Varlan.  Judge Varlan also ordered the defendant to forfeit $3.6 million.  Hofstetter was found guilty by a jury on Feb. 13, 2020, of Racketeer Influenced and Corrupt Organization (RICO) conspiracy, two counts of drug conspiracy, money laundering offenses, and maintaining drug-involved premises. 

“This defendant reaped millions of dollars in personal profits by operating destructive opioid pill mills in multiple states, inflicting lasting harm on multiple communities,” said Acting Assistant Attorney General Brian C. Rabbitt of the Justice Department’s Criminal Division.  “This prosecution demonstrates the Department of Justice’s steadfast commitment to combatting the opioid crisis and holding responsible theunscrupulous individuals who seek to profit from it.”

“The Eastern District of Tennessee remains at the forefront in the battle against illegal pain clinics and the mass-prescribing of opioids,” said U.S. Attorney J. Douglas Overbey for the Eastern District of Tennessee.  “Through the cooperation and hard work of our local, state, and federal agencies, we continue to pursue and prosecute those who seek to endanger our communities by illegally distributing prescription pain killers. Let this sentencing serve as a deterrent for those who seek to profit from fueling a tragic cycle of addiction and pain killer abuse.”

“The nation remains in the midst of a drug crisis that is often fueled by pill mills. Drug addiction destroys lives and devastates families,” said Special Agent in Charge Joseph Carrico of the FBI’s Knoxville Field Office.  “The FBI will work tirelessly with our federal, state, and local law enforcement partners to investigate, arrest, and hold accountable those who use illegal means and criminal behavior to take advantage of others.”

The evidence at trial proved that the pill mills owned and operated by Hofstetter and her co-defendants distributed over 11 million tablets of oxycodone, oxymorphone, and morphine that generated over $21 million in revenue, with a corresponding street value of $360 million. The conspiracy involved four separate clinics in Tennessee, each of which the jury determined were drug-involved premises, i.e., pill mills.  

Before coming to Tennessee, Hofstetter worked at a pill mill in Hollywood, Florida, owned by three of her co-defendants.  The evidence at trial demonstrated that, as law enforcement shut down hundreds of pill mills in South Florida during that time, Hofstetter and her co-defendants planned the move to East Tennessee, where a large percentage of these clinics’ opioid-addicted customers lived.

Hofstetter’s role in Tennessee was to run the pill mills and ensure that patient volume remained high, thus guaranteeing enormous profits for Hofstetter and her co-defendants.  Once in Tennessee, however, Hofstetter opened her own pill mills in secret from her Florida employers and competed against them.  Hofstetter personally reaped over $4 million from her role in these offenses.

This sweeping prosecution, which has resulted in approximately 140 convictions so far, is the result of an investigation by the U.S. Attorney’s Office for the Eastern District of Tennessee, the Criminal Division’s Organized Crime and Gang Section (OCGS), and the FBI High Intensity Drug Trafficking Area (HIDTA), comprised of investigators assigned to the task force by the Loudon County Sheriff’s Office, Knoxville Police Department, Blount County Sheriff’s Office, Roane County Sheriff’s Office, Harriman Police Department, and Clinton Police Department

Other agencies provided invaluable assistance, including the Rome Attaché of the Justice Department’s Office of International Affairs, FBI’s liaison in Rome, FBI’s Miami Field Office, the Hollywood Florida Police Department, the U.S. Department of Health and Human Services, the Tennessee Department of Health, and the Drug Enforcement Administration’s Knoxville Diversion Group. 

Santa Ana, California: Doctor Among 10 Facing Federal Drug Trafficking Charges Related to Distribution of Opioids Through Bogus Pain Clinics Across SoCal (U.S. Attorney’s Office, Central District of California, August 5, 2020)

Law enforcement authorities arrested four defendants charged in two federal grand jury indictments alleging a narcotics trafficking ring that sold illegal opioid prescriptions for cash through a series of sham medical clinics.

Those charged in the indictments include Dr. John Michael Korzelius, 68, a.k.a. “Dr. K,” of Camarillo, who worked at a Santa Ana Pain Management Clinic where he allegedly wrote medically unnecessary prescriptions to “patients” who paid cash. For two years, Korzelius and other medical professionals working under his guidance prescribed approximately 439,090 pills of 30mg oxycodone – the highest dose of short-acting oxycodone available and the dose most popular for the drug-abusing population, according to court documents.

The charges in this matter result from an investigation by agents with the DEA and IRS Criminal Investigation into ChiroMed, which operated a group of chiropractic, medical, and wellness clinics in Los Angeles, Orange, and San Bernardino counties. Korzelius, along with other medical professionals, including physician’s assistants, allegedly met with fraudulent patients and provided them with unnecessary prescriptions for drugs, including oxycodone.

As a result of a two-year investigation into the fraudulent medical clinics, DEA agents seized 20,737 oxycodone pills and $177,610 in cash. Law enforcement intercepted a mailed parcel containing a teddy bear stuffed with two bags of oxycodone pills.

The investigation into the Sham Medical Clinics was handled by the Drug Enforcement Administration and IRS Criminal Investigation. The Department of Health and Human Services, Office of Inspector General, and the Torrance Police Department provided substantial assistance. The investigation of Majid Nojavan was handled by Homeland Security Investigations and the Costa Mesa Police Department.

Delaware Chronic Pain Management and Detox Center—Trolley Square Doctor Operated a Pain Clinic as a Pill Mill, at which drug dealers and addicts could buy prescriptions for frequently abused controlled substances without any medical necessity (Karl Baker & Nick Perez, Delaware News Journal, April 6, 2020)

Employees at the clinic, which operated under the legal name DE CPM and Detox Center LLC, deposited $13.7 million into a WSFS Bank account. The money flowed to the clinic because it prescribed oxycodone, morphine, oxymorphone, and methadone, prosecutors said.

Why Were Millions of Opioid Pills Sent to a West Virginia Town of 3,000? (The Guardian, Chris McGreal, October 2019)

Texas Healthcare Fraud Takedown Results In Charges Against 58 Individuals (U.S. Attorney’s Office, Northern District of Texas, September 18, 2019)

The Justice Department coordinated health care fraud enforcement operation across the state of Texas, involving charges against a total of 58 individuals across all four federal districts in Texas for their alleged involvement in Medicare fraud schemes and networks of “pill mill” clinics resulting in $66 million in loss and 6.2 million pills.  Of those charged, 16 were doctors or medical professionals, and 20 were charged for their role in diverting opioids.   

Florida’s Pill Mills Were a Gateway to the Opioid Crisis (Terry Spencer, Associated Press, July 20, 2019)

Florida’s pill mills “opened fast and furious because there was very little regulation … and the majority of law enforcement was not trained to handle the movement of legal drugs for illegal purposes,” said a sheriff’s narcotics investigator in Broward County, the epicenter of the pill-mill boom.

By the clinics’ peak in 2010, 90 of the nation’s top 100 opioid prescribers were Florida doctors, according to federal officials, and 85 percent of the nation’s oxycodone was prescribed in the state. That year alone, about 500 million pills were sold in Florida. The number of people who died in Florida with oxycodone or another prescription opioid in their system hit 4,282 in 2010, a four-fold increase from 2000, with 2,710 of the deaths deemed overdoses, according to a state medical examiners’ report.

Pill Mill Uncovered in Houston, Texas (KPRC, YouTube Video, 2018)

Purdue Pharma Pushed Pill-Mill Doctors to Shell Out OxyContin, Hid Evidence (Jamie Satterfield, KnoxNews, July 14, 2018)

Makers of the opioid OxyContin promised to report pill mills to law enforcement in Tennessee but instead hid evidence and pushed providers to dole out more pills at higher doses for longer periods, even providing “savings coupons” to cash-paying addicts, court records show.

Police Shut Down Alleged ‘Pill Mill’ That Operated in York and 16 Other Pennsylvania Counties (Ted Czech, York Daily Record, May 23, 2018)

12 Charged in Pill Mill Operation in Southern West Virginia (Wendy Holdren, CNHI News, February 2018)

The indictment charges the owners, managers and physicians associated with HOPE Clinic, which operated as a purported pain management clinic in Beckley, Beaver and Charleston, as well as Wytheville, Va., and a related company with conspiring to distribute oxycodone and other Schedule II controlled substances, not for legitimate medical purposes and outside the usual course of professional practice, from November 2010 to June 2015.

The following individuals were charged in the indictment: James H. Blume Jr.; D.O, Mark T. Radcliffe; Joshua Radcliffe; Michael T. Moran, M.D.; Sanjay Mehta, D.O.; Brian Gullett, D.O.; Vernon Stanley, M.D.; Mark Clarkson, D.O.; William Easley, D.O.; Paul W. Burke, M.D.; Roswell Tempest Lowry, M.D.; and Teresa Emerson, LNP.

“As of today, there are 69 counts. Ten doctors in total. Clinics from Beckley to Beaver, and Charleston to Wytheville. Lots and lots of pills, and even more misery,” said U.S. Attorney Mike Stuart. “Home-grown drug dealers hidden behind the veil of a doctor’s lab coat, a medical degree and a prescription pad are every bit as bad as the heroin dealers from Detroit who bring their poisons to West Virginia. Today’s 69-count indictment is the continuation of our efforts to hold accountable those who prey on the good citizens of West Virginia.”

In addition to the conspiracy charge, the indictment charges defendants Blume and Mark Radcliffe with maintaining drug-involved premises in Beckley, Beaver and Charleston, and includes 62 counts charging several physicians with distribution of controlled substances not for legitimate medical purposes and outside the usual course of professional practice.

The indictment also charges Sanjay Mehta, D.O., a former physician at the Beckley and Beaver HOPE Clinic locations, with two counts of distribution of controlled substances causing death, and charges 10 of the defendants with conspiracy to launder drug proceeds by paying bonuses to HOPE Clinic physicians and employees of Patients, Physicians, and Pharmacists Fighting Diversion, Inc. (PPPFD), to encourage continued prescribing of Schedule II narcotics to customers.

According to the indictment, defendant James H. Blume Jr., D.O., the owner of the HOPE Clinic, entered into a Physician Practice Management Agreement with defendant Mark T. Radcliffe, owner of PPPFD, to be the practice manager of the HOPE Clinic. The indictment alleges that together Blume and Radcliffe operated HOPE Clinic as a cash-based business that prescribed oxycodone and other Schedule II controlled substances to customers, while refusing to accept insurance, charging in-state customers at least $275 for an initial appointment, and at least $160 for each subsequent appointment. Out-of-state customers paid as much as $330 for initial visits and at least $185 for subsequent visits.

The indictment alleges that HOPE Clinic practitioners prescribed thousands of oxycodone-based pills to individual customers and some HOPE Clinic locations, including Beaver and Charleston, averaged 65 or more customers a day during a 10-hour workday with only one practitioner working.

In addition, the indictment alleges that Blume and Mark T. Radcliffe contracted the services of physicians without any knowledge of pain management who consistently conducted cursory, incomplete, or no medical examinations of clinic customers and provided large amounts of Schedule II prescription medications to customers that they knew, and had reasonable cause to believe, were drug addicts.

The indictment further alleges that Mark T. Radcliffe and his son, Joshua Radcliffe, neither of whom had any formal medical education or training, instructed medical practitioners at HOPE Clinic to provide customers with prescriptions for Schedule II controlled substances, sometimes in direct contrast with the practitioners’ clinical opinions.

If convicted on all charges as alleged in the indictment, Dr. Blume and Mark Radcliffe face up to 100 years; Joshua Radcliffe faces up to 20 years; Teresa Emerson faces up to 20 years; Michael Moran faces up to 60 years; Sanjay Mehta faces a 40-year mandatory minimum sentence up to life imprisonment; Vernon Stanley faces up to 240 years; Brian Gullett faces up to 340 years; Mark Clarkson faces up to 80 years; William Earley faces up to 200 years; Paul Burke faces up to 180 years; and Roswell Tempest Lowry faces up to 120 years. In a related case, John Pellegrini faces up to 20 years imprisonment for his role in a conspiracy to commit money laundering.

“We are committed to protecting all those in government health programs,” said Maureen R. Dixon, Special Agent in Charge of the Office of Inspector General for the U.S. Department of Health and Human Services. “Working side by side with our law enforcement partners we will aggressively investigate charges of medical providers needlessly prescribing deadly opioids.”

Kimberly Lappin, Special Agent in Charge, IRS Criminal Investigation, Washington D.C. Field Office, added, “Those who facilitate the abuse of controlled dangerous substances are negatively impacting our entire community and will be held accountable. This indictment is a reminder that IRS-CI will remain vigilant in our financial investigations and will continue to work with our law enforcement partners to combat this type of conduct.”

The Pill Mill That Ravaged Portsmouth (Philip Eli, Cincinnati Magazine, July 5, 2017)

SEATTLE, WASHINGTON. Prison for Ex-Cop Who Led $9 Million Painkiller ‘Pill Mill’ (Levi Pulkkinen, Seattlepi Staff, January 27, 2017)

Juan Gallinal was swept up in a Drug Enforcement Administration operation targeting an online pharmacy he helped build into a leading illicit supplier of pain medication. Gallinal, 49, of Pembroke Pines, Florida, worked as a Police Officer in Virginia before getting into the pharmaceutical business.

Federal prosecutors said Gallinal organized the online pharmacy operation. He and others took over a small drugstore and then turned it into a massive online pill mill.

“This defendant is one of the ‘founding fathers’ of this internet pharmacy business that exploited the drug addiction of people across the country for his own gain,” said Annette L. Hayes, U.S. Attorney for Western Washington. “Using a sham owner, shell corporations and databases hidden on a server in Switzerland, Mr. Gallinal tried to hide his business and his role from the law.”

Defense Attorney Jeffrey Kradel noted that Gallinal’s crimes wouldn’t have been possible without what he described as the “knowing assistance” of drug manufacturers and distributors, among others. “Those larger entities, whose profits from these enterprises dwarf the dollars Mr. Gallinal generated, walk away with large fines, but no criminal prosecution,” Kradel said in court papers.

The City of Everett filed a lawsuit against Purdue Pharma, maker of the ubiquitous painkiller OxyContin. According to an (Everett) Herald report, city officials claim Purdue failed to stop selling its drug to pill mills that in turn supplied addicts across Snohomish County and elsewhere.

Maryville Pill-Mill Providers ‘Willfully Blind’ to Role in Opiate Epidemic (Jamie Satterfield, KnoxNews, November 2016)

Oxycodone was a money-maker for the drug makers, pharmacies, and, through increased patient visits for doctors. By the early 2000s, a cottage industry sprang up – pain management clinics where those with complaints of chronic pain were supposed to find long-term solutions but instead found legal prescriptions for massive doses of the drug. There were no rules. Anyone could open one.

There was one key ingredient, though. Someone with legal authority to prescribe opiates was required, and that meant doctors, physician’s assistants, and nurse practitioners were in high demand. 

The money was good: $500 to $1,000 a day. The job was easy: ask a question or two and write a prescription. Sometimes, the questioning wasn’t even necessary, just the signature.

Sure, these medical providers admitted they were a bit queasy. After all, none of them knew a thing about pain management and only slightly more about the deadly drugs they were doling out. And, there were plenty of warning signs that the clinic in which they worked was no clinic at all: cash-only payments, gun-toting workers, entire families as patients with identical pain complaints, no medical referrals, no prior testing, no medical equipment, no appointments and a boss with zero medical experience.

But clinics like the one at which these eight medical providers worked were perfectly legal and completely unregulated, so, they say, it was easy to convince themselves they were doing nothing wrong.

That willful blindness put Lewis and his seven medical co-workers at the Breakthrough Pain Therapy Center in Maryville on the road to prison. Lewis, physician’s assistant Walter David Blankenship, nurse practitioners Jamie Chiles Cordes, Sherry Ann Fetzer, Buffy Renee Kirkland, and Donna Jeanne Smith, and supervisory doctors James Brian Joyner and Deborah Gayle Thomas pleaded guilty to federal drug conspiracy charges.

Each worked at the clinic part-time in 2009-2010, earning anywhere from $500 a day to, for the doctors, $1,000 a day. Their boss, Sandra Kincaid, was an opiate addict who opened the clinic with her husband, Randy Kincaid, as a way to make money and feed her addiction. She not only ran the clinic but paid patients to give her a percentage of the pills they received – known as a “sponsor” in the pill mill game. In just 17 months, the clinic pulled in $12.5 million – all in cash.

Federal authorities raided the clinic in December 2010 and indicted the Kincaids, two family members, and Breakthrough’s medical staff, not for overprescribing or fraud, but for dealing drugs – just like the hustlers on the street peddling crack cocaine.

Among the law changes in Tennessee is a requirement that doctors own pain clinics. But the 2015 case of a $17.5 million pill-mill operation in Knoxville and Lenoir City showed pill mills still exist with a doctor paid to serve as nominee owner. A database was set up to log every opiate prescription, and both pharmacists and doctors are required to use it to ferret outpatients who are going from one doctor to the next to get drugs. But identifying potential drug seekers doesn’t stop doctors from writing prescriptions to them or pharmacies from filling them so long as the supply is limited to 30 days.

In East Tennessee, where opiate addiction is rampant, federal prosecutors are taking an aggressive approach, using drug conspiracy laws against medical providers. 

DEA ‘Pill Mill Crackdown May Be Causing an Unintended Consequence, Rachel Gotbaum, WBUR, August, 2015)

Chris Young was crushed by a car he was working under. “He was crushed accordion style,” said his wife Lesley. The accident left Young, 45, almost completely paralyzed and in a wheelchair. He does have some sensation in his legs, but that is also where he experiences acute pain. To control the pain, Young was prescribed high doses of narcotic painkillers. But since he moved to Florida, he was having trouble getting his medications. His pharmacy runs out every month. Young’s pharmacist was Bill Napier, who owns Panama Pharmacy in Jacksonville, Florida. Napier said since there has been a major crackdown on illegal narcotics, he can no longer serve customers who legitimately need painkillers. The wholesalers will no longer distribute the amount of medications he needs. “I turn away sometimes 20 people a day.”

Last year, Napier was visited by Drug Enforcement Administration agents who told him he was dispensing too many narcotics. They took all of his opioid prescriptions and held on to them for seven months. Napier hired a lawyer and paid for criminal background checks on his patients taking narcotics to satisfy the DEA.

“We’re being asked to act as quasi law enforcement people to ration medications,” says Napier. “I have not had training of rationing of medications.

Florida was considered the epicenter for the trafficking of illegal prescription narcotics. The DEA and local law enforcement shut down more than 250 so-called “pill mills,” clinics where doctors could sell narcotics directly to people for cash. Now Florida doctors can no longer dispense narcotics directly to patients and wholesalers, which were also fined, are limiting the amount they sell to pharmacies.

Jack Riley, deputy administrator of the DEA, credited a decline in opioid overdose deaths in Florida with an upsurge in law enforcement activity. But he said these efforts cannot be blamed for any claim of rationing of painkillers.

Drug Enforcement Administration Raids ‘Pill Mills in Four Southern States—Arkansas, Alabama, Louisiana, and Missippii—part of a 15-month investigation (Mark Potter, NBC News, May 20, 2015)

The Drug Enforcement Administration and other authorities raided pharmacies, pain clinics, and other facilities in four states as part of an aggressive crackdown on prescription pain drug abuse.

The morning busts in Arkansas, Alabama, Louisiana, and Mississippi are part of a 15-month operation by the DEA drug diversion unit. The sources said 1,000 agents and officers conducted the raids.

A federal law enforcement source told NBC News that “Operation Pilluted” was the “single largest pharmaceutical operation in DEA history.” It is focused on the illegal sale and distribution of pain killers, including oxycodone and hydrocodone.

In Arkansas, federal prosecutor Christopher Thyer described one sting in which undercover officers paid $200 to get prescription drugs from a clinic without ever being examined.

Gov. Robert Bentley of Alabama, himself a physician, described the doctors suspected in the raids as “an embarrassment to the medical profession.”

“When they choose to overprescribe narcotics to patients, and they know that these patients may be or are abusing them, then they change from being a physician to really being a drug dealer,” he said.

Florida became a pill popper’s paradise and the main source of an illicit prescription drug pipeline. Lax laws and little oversight led to a booming number of storefront pain management clinics that dispensed painkillers, particularly Oxycodone.

Christopher George and Jeffrey George, twin brothers, operated, managed, and financed four pain management clinics in Broward and Palm Beach Counties. The George Brothers and their families were targeted in federal and state probes for overprescribing the pills and several overdose deaths. 32 Defendants in connection with charges stemming from Operation Oxy Alley were convicted due to a coordinated investigation into “Pill Mills” in Florida.

The FBI and IRS, along with the Palm Beach County Sheriff’s Office and other law-enforcement agencies, spent 14 months investigating allegations that the George Brothers illegally sold drugs and laundered money.

Wellington’s Pill Mill Kingpins: One Ratted Out His Own Mother (Palm Beach Post)

Prosecutors said Christopher and Jeffrey George of Wellington ran the largest pill mill operation in the country. Several family members were involved, including their mother, whom Jeff testified against.

By the time the operation fell apart in March 2010, The George Brother’s physicians had prescribed 18 million oxycodone pills. While many of the pills were filled by outside pharmacies, American Pain’s doctors themselves ordered 6.2 million pills, dispensed by a staff that, rather than being composed only of properly trained technicians, included “an individual who was otherwise employed as a bikini model.”

Thirty-two defendants, including 13 doctors, were charged in an indictment for their participation in, among other things, the illegal distribution of pain killers and steroids through pill mills operating in Broward and Palm Beach Counties in Florida and through the Internet, respectively.

Gov. Charlie Crist signed a bill that allows the government to create a database to monitor prescriptions for powerful and addictive drugs like Oxycodone and Xanax. The state filed bills that would target clinic operators and doctors who are getting rich selling drugs to all comers. Investigators say these operators were making bank.

A single clinic run by the George Brothers—records show they opened at least five in South Florida since 2008—netted more than $14 million in one year alone.

As many as 250 people a day streamed in to see five doctors who were paid based on how many patients they treated. One physician earned $44,850 weekly at American Pain, a cash-only operation in 2009. Each of the five doctors ordered roughly half a million oxycodone tablets. However, the doctors walked away with only a fraction of the total haul, prosecutors said.

The case, dubbed Operation Oxy Alley, resulted from the ongoing efforts by the Organized Crime Drug Enforcement Task Force (OCDETF), a partnership between federal, state, and local law enforcement agencies. The OCDETF mission is to identify, investigate, and prosecute high-level members of drug trafficking enterprises, bringing together the combined expertise and unique abilities of federal, state, and local law enforcement.

Christopher George was released from federal prison in February 2022.

United States of America v. Christopher Paul George, Jeffrey George et al. (August 11, 2011)

Operation Pill Nation

In February 2011, federal, state, and local law enforcement agencies concluded Operation Pill Nation—an investigation that resulted in the arrest of 22 individuals and the seizure of $2.2 million and 70 vehicles.

Among those arrested were doctors who had conspired to distribute and dispense more than 660,000 dosage units of oxycodone. Operation Pill Nation documented 340 undercover buys of prescription drugs from 60 doctors at more than 40 pill mills in South Florida during the past year.

According to the indictment, the defendants operated pill mills that offered patients prescriptions for oxycodone and other controlled substances without a proper medical diagnosis or purpose. The indictment alleged that the defendants marketed pill mills as pain management clinics through more than 1,600 Internet sites.

Patients using the pill mills were required to make cash payments as a “visit fee” and were often directed to obtain MRI examinations. The pill mills would then purposely misinterpret the MRIs to justify the prescriptions. For an additional fee, the pill mills would falsify the results of patients’ urinalyses to justify high and often dangerous dosages of prescription opioid pain medications (Drug Enforcement Administration).

What is Oxycodone and How Is It Used (United States Drug Enforcement Administration)

Understanding Drug Overdoses and Deaths (Centers for Disease Control and Prevention)

Researchers from the Centers for Disease Control and Prevention report that Schedule II prescription painkillers, like oxycodone, cause more drug overdose deaths than cocaine and heroin combined. Oxycodone and other Schedule II drugs have a high potential for abuse and can be crushed and snorted or dissolved and injected to get an immediate high. This abuse can lead to addiction, overdose, and sometimes death.


American Pain was a one-stop shop, supplying both prescriptions and painkillers. At the door, a hulking bouncer warned people not to snort their pills in the parking lot. That would attract the kind of attention that the clinic’s owners, twin brothers Chris and Jeff George, were trying to avoid.

But it was too late. Local and federal investigators were nearby, watching every move.

These are scenes from a CNN Films documentary, “American Pain,” which details the George brothers’ rise and fall as opioid kingpins. 

“They became the largest street-level distribution group operating in the entire United States,” McKenzie added. “Nobody put more pills on the streets than they did. Nobody … and they were operating in broad daylight.”

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Pain Killer by Barry Meier

Between 1999 and 2017, an estimated 250,000 Americans died from overdoses involving prescription painkillers, a plague ignited by Purdue Pharma’s aggressive marketing of OxyContin. Families, working class and wealthy, have been torn apart, businesses destroyed, and public officials pushed to the brink. Meanwhile, the drugmaker’s owners, Raymond and Mortimer Sackler, whose names adorn museums worldwide, made enormous fortunes from the commercial success of OxyContin.
In Pain Killer, Barry Meier tells the story of how Purdue turned OxyContin into a billion-dollar blockbuster. Powerful narcotic painkillers, or opioids, were once used as drugs of last resort for pain sufferers. But Purdue launched an unprecedented marketing campaign claiming that the drug’s long-acting formulation made it safer to use than traditional painkillers for many types of pain. That illusion was quickly shattered as drug abusers learned that crushing an Oxy could release its narcotic payload all at once. Even in its prescribed form, Oxy proved fiercely addictive. As OxyContin’s use and abuse grew, Purdue concealed what it knew from regulators, doctors, and patients.
Here are the people who profited from the crisis, those who paid the price, those who plotted in boardrooms, and those who tried to sound alarm bells. A country doctor in rural Virginia, Art Van Zee, took on Purdue and warned officials about OxyContin abuse. An ebullient high school cheerleader, Lindsey Myers, was reduced to stealing from her parents to feed her escalating Oxy habit. A hard-charging DEA official, Laura Nagel, tried to hold Purdue executives to account.
In Pain Killer, Barry Meier breaks new ground in his decades-long investigation into the opioid epidemic. He takes readers inside Purdue to show how long the company withheld information about the abuse of OxyContin and gives a shocking account of the Justice Department’s failure to alter the trajectory of the opioid epidemic and protect thousands of lives. Equal parts crime thriller, medical detective story, and business exposé, Pain Killer is a hard-hitting look at how a supposed wonder drug became the gateway drug to a national tragedy.

What Are Pill Mills?

Pill mills are places where people can get prescription drugs without a legitimate medical reason. In most cases, pill mills are run by doctors or other healthcare professionals who prescribe drugs like opioids for cash. These prescriptions are often given without any medical exam or testing, and they’re usually offered in large quantities. Pill mills fuel the opioid epidemic by making it easy for people to get their hands on these dangerous drugs.

Often, these operations are in rural areas or small towns without many healthcare options. This means that people have to travel long distances to get to a pill mill, making it even easier for them to become addicted to the drugs they’re prescribed.

Pill mills are often located in storefronts or strip malls and usually don’t have any medical equipment on site. In some cases, people who work at pill mills may even dress like they’re not in a medical setting. This can make it difficult for people to know if they’re going to a legitimate doctor’s office or a pill mill.

The advent of pill mills has been credited to a man named David Procter. A flamboyant, diamond-and-fur-wearing Canadian ex-pat, Procter practiced across the river from Portsmouth in South Shore, Kentucky, and his cash-only, heavy-prescription model would become infamous. “Procter’s business model spread like a virus, unleashing unstable doctors on a vulnerable region,” writes Sam Quinones, author of the award-winning book Dreamland: The True Tale of America’s Opiate Epidemic. Many of the clinics that followed Procter’s example displayed the kinds of operating procedures described in a 2012 article on pill mills in Kentucky Law Enforcement magazine: “No physical exams are given; only cash is accepted as payment; excessive traffic to and from the doctor’s office; complaints from pharmacists about doctor’s practices; large cash deposits at the bank; [and] patients are in and out of the doctor’s office in minutes.”

Signs of a Pill Mill

A few signs can indicate whether or not a doctor’s office is a pill mill. First, pill mills often prescribe large quantities of drugs without requiring a medical exam or testing. They may also prescribe multiple opioids to the same patient, which is extremely dangerous. In addition, pill mills may require cash payment only, and they may not accept insurance.

If you suspect a medical office may be a pill mill, it’s important to report it to the authorities.

What Are Some Signs There Is a Pill Mill In Your Area?

Pill mills have been around in almost every one of the United States. Many are found in the Southern States. However, there are still pill mills opening up around the country. If you suspect there is a pill mill in your area, some signs to confirm this may include the following:

  • Cash is the only form of payment accepted.
  • Physical exams are not given.
  • Prescription pills are the only way doctors treat pain.
  • Crowds are formed around the building in lines.
  • Many cars are in and out of the building parking lot.
  • Pharmacists complain about the doctors.
  • Other businesses complain about the office or facility.
  • Patients aren’t in the building long for their appointments.
  • Shady or unusual characters around the building.
  • X-rays and medical records aren’t needed for appointments.
  • Doctors send patients to a specific pharmacy.
  • Patients can pick what medicine they want.
  • Drugs are being used and sold right outside the building.
  • Security guards are on the premises.

If you recognize any of these signs, you can submit your anonymous tip through the DEA online Tip Line and report the doctors or facility. Pill mills are a problem. If the citizens of the community report they see signs of suspicious activity and more businesses keep an eye out for the above-mentioned signs as well, hopefully, these pill mills can be limited.

America’s Pain Mills (American Addiction Centers Editorial Staff, November 30, 2023)

“We face a moment in our country where more than 100,000 of our fellow Americans die each year from drug overdoses,” United States Attorney Christopher R. Kavanaugh said. “We must do all we can to support those battling addiction disorders and prosecute those who prey on this disease.”

If you are aware of controlled substance violations in your community, you can submit your anonymous tip through the DEA online Tip Line

Related Investigations

How Pain Clinic Owners Turned Patients’ Pain into Enormous Profits

How to Recognize a Pain Pill Mill in Your Community

Authorities Crack Down on Pharmacists Fulfilling and Dispensing Massive Amounts of Pain Pills

How Federal Agencies are Shutting Down Maryland Pain Clinics Operating as Pill Mills

How Authorities are Dismantling Ohio Pain Management Clinics Prescribing Enormous Amounts of Opioid Painkiller Pills

How Authorities Have Shuttered Georgia Pain Clinics Massive Pain Pill Distribution

How Authorities are Dismantling Tennessee Pain Clinics Prescribing Massive Quantities of Opioid Pain Pills

How Authorities Are Cracking Down on Virginia Pain Clinics Massive Pain Killer Pill Operations

How Authorities Are Shutting Down Texas Pain Clinics Enormous Pill Prescriptions

How Authorities Are Cracking Down on Rogue Pain Clinics in Florida

How the George Brothers Illegal Oxycodone Pain Pill Distribution Contributed to the Drug Epidemic and Oxy-Related Overdoses in Florida.

How State and Federal Authorities are Dismantling Pill Mills in the United States