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Doctors in Texas Alert: Feds Are Targeting Health Care Fraud Arrests

Health Care Fraud Arrests of Doctors in Texas

The government’s position is that “health care fraud” can involve all sorts of nefarious activity by medical professionals.  There’s lots of precedent involving federal investigations and arrests based upon overbilling of the federal insurance programs Medicare and Medicaid, for instance.  See, e.g., our discussion in “Arresting Texas Doctors for Health Care Fraud: What You Need to Know.”

However, “health care fraud” prosecutions can also involve prescription drugs – specifically pain medications that are addictive.  Like the opioids that made the news this week with the Trump Administration’s announcements.


White House Opioid Panel Wants State of Emergency Declared

A commission established by President Trump has been working hard in its study of the misuse of opioid medications in this country.   It’s called the “President’s Commission on Combatting Drug Addiction and the Opioid Crisis.

And the Commission has reported back its interim findings to the President.  Its suggestion is a federal “state of emergency” be declared to address the opioid crisis.

For details, read the Scientific American article by Lev Facher entitled “White House Opioid Panel Urges Trump to Declare State of Emergency,” published on August 1, 2017.

U.S. Attorney General Announces New DOJ Task Force to Fight Doctors

As a direct result of this Commission report, the top federal prosecutor, Attorney General Jeff Sessions, announced the creation of a new “Opioid Fraud and Abuse Detection Unit,” designed to fight “opioid health care fraud using data to identify and prosecute individuals that are contributing to this prescription opioid epidemic.”

From the Sessions press release:

“… the Department will fund twelve experienced Assistant United States Attorneys for a three year term to focus solely on investigating and prosecuting health care fraud related to prescription opioids, including pill mill schemes and pharmacies that unlawfully divert or dispense prescription opioids for illegitimate purposes.”

Specifically, the Justice Department is paying 12 federal prosecutors to investigate and prosecute doctors exclusively.

None of them are from Texas.  They are based in the following federal districts:

  • Middle District of Florida,
  • Eastern District of Michigan,
  • Northern District of Alabama,
  • Eastern District of Tennessee,
  • District of Nevada,
  • Eastern District of Kentucky,
  • District of Maryland,
  • Western District of Pennsylvania,
  • Southern District of Ohio,
  • Eastern District of California,
  • Middle District of North Carolina, and
  • Southern District of West Virginia.

What This Means for Doctors in Texas

So, what about Texas?  All this means that doctors in Texas need to be alert and aware that they may be subject to a state or federal investigation of their practices because law enforcement is hot for opioids now – and that’s going to be the case for the near future.

And just because a doctor isn’t operating a “pill mill” doesn’t mean that he or she cannot be investigated for possible health care fraud charges based upon prescription pain medications.

It also doesn’t mean that the doctor will not be arrested on health care fraud charges – even if they are innocent of any wrongdoing.

Consider the following:

Fraud Arrests Based On Prescription Pain Killers

Patients can become addicted to prescription pain medication after they’ve been prescribed pain killers after an injury or accident.  Driven to feed that pain pill addiction, the patient can “doctor shop” after their treating physician refuses to supply them.

Doctor Shopping Patients

Doctor shopping involves a patient going to see several doctors at once, so he or she can get a number of prescriptions for prescription pain killers.  Usually these are the popular opioids like Hydrocodone.

From a federal prosecutor’s standpoint, hydrocodone is a Schedule II drug.  It’s a felony under federal law to abuse this drug because it is a legally “controlled substance.”   Accordingly, it is monitored by both the federal government and the State of Texas.

Patients who are caught “doctor shopping” face serious felony charges – but so may the doctors and pharmacists  involved in prescribing the pain medication.   

Patients under the Influence of Pain Medication

Another problem for doctors who prescribe pain medication:  the actions of those patients while they are taking the pills.  Consider the example provided in the January 2016 issue of Texas Medicine, in an article written by Joey Berlin entitled “Pain Rules Are a Pain for Doctors.”

Seems a Conroe car accident resulted in the deaths of four people, and the driver admitted to the police that he was under the influence of opioid pain killers at the time of the crash.  So, law enforcement investigators turned their focus to the prescription itself.

The police, using the pill bottles found in the driver’s car (prescriptions for oxycodone and valium), got a search warrant for the doctor’s clinic.  A judge agreed there was probable cause to invade the privacy of the clinic based upon the two pill bottles found in the DUI driver’s car.

Result?  The doctor was arrested for 3 counts of possession of a controlled substance; 4 counts of fraudulent possession of a controlled substance or prescription form; and 3 counts of diversion of controlled substances.

As the Texas Medical Association’s magazine article points out, this case is an example of how the police (and the DEA) can use as a stepping stone to investigate and arrest Texas doctors for felony drug charges.

While the state rules have changed since the Conroe incident, the overall scenario of a DUI car crash snowballing into an investigation and possible arrest of a prescribing physician remains.

Prescription Pain Medication: Investigation, Arrest, Charge, Conviction

Doctors must understand that there are a variety of ways that they can come under the scrunity of state or federal investigators who are zealously going after villains in this national opioid crisis.

  • This will mean that doctors (and pharmacists) will be investigated – and reputations will be tarnished even if nothing comes of it.
  • Doctors will be arrested – even if they are innocent of wrongdoing.
  • Doctors will be charged – even if the charges are later dropped or dismissed.
  • And finally, some physicians will face trial (and some may take a plea deal) for prescription pain medication health care fraud based upon opioids.

Any doctor in the State of Texas currently prescribing pain medication or has done so in the past needs to be prepared to deal with these realities.


For more information, check out our web resources, read Michael Lowe’s Case Results, and read his in-depth article,” Pre-Arrest Criminal Investigations” as well as:


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