Prescription Drug Fraud Prosecutions
1. Overview
Prescription drug fraud involves the illegal acquisition, distribution, or misuse of prescription medications. It encompasses activities such as:
Forging or altering prescriptions.
Doctor shopping (obtaining prescriptions from multiple doctors).
Illegal distribution or sale of prescription drugs.
Healthcare fraud related to prescription medications.
Due to the opioid epidemic and rise in prescription drug abuse, federal and state authorities have intensified enforcement against these crimes.
2. Legal Framework
Federal Statutes Commonly Used:
21 U.S.C. §§ 841 & 843 – Controlled Substances Act: Prohibits illegal manufacture, distribution, and possession of controlled substances.
18 U.S.C. § 1347 – Health Care Fraud: Covers fraudulent schemes to obtain prescription drugs through medical billing fraud.
18 U.S.C. § 1001 – False Statements: Used when false information is provided on prescription forms or to pharmacies.
21 U.S.C. § 829 – Prescription Drug Fraud specific regulations.
State Laws – Each state has statutes criminalizing prescription fraud, often mirroring federal laws but varying in penalties.
3. Elements of Prescription Drug Fraud
Intentional deception or misrepresentation to obtain or distribute prescription drugs.
Use of forged or altered prescriptions, false information, or illegal means.
Knowledge that the drugs are controlled substances or prescribed unlawfully.
Resulting in unlawful possession, distribution, or economic harm.
4. Case Law Examples
Case 1: United States v. Moore, 423 U.S. 122 (1975)
Facts:
Moore, a physician, prescribed narcotics outside the usual course of professional practice for non-legitimate medical reasons.
Issue:
Whether a doctor prescribing controlled substances for non-medical purposes violated the Controlled Substances Act.
Holding:
The Supreme Court held that doctors are not exempt from prosecution if they prescribe controlled substances without a legitimate medical purpose.
Significance:
Set a clear precedent that medical professionals could be prosecuted for prescription drug fraud.
Case 2: United States v. Angelilli, 2002 WL 31479446 (D. Conn.)
Facts:
Angelilli was charged with prescription fraud for submitting false prescriptions and billing Medicare fraudulently.
Issue:
Whether fraudulent billing and false prescriptions constituted prescription drug fraud and healthcare fraud.
Holding:
Court upheld convictions under both the Controlled Substances Act and healthcare fraud statutes.
Significance:
Illustrates overlapping federal laws used to prosecute complex prescription drug fraud schemes.
Case 3: United States v. Ghanem, 684 F.3d 1012 (9th Cir. 2012)
Facts:
Ghanem was convicted for illegally distributing oxycodone by writing prescriptions without medical necessity.
Issue:
Whether prescribing controlled substances without legitimate medical purpose violates federal law.
Holding:
The 9th Circuit upheld the conviction, reinforcing the standard set in Moore.
Significance:
Confirms that doctors can be prosecuted for acting outside professional standards.
Case 4: United States v. Patel, 778 F.3d 607 (7th Cir. 2015)
Facts:
Dr. Patel was convicted for operating a “pill mill,” prescribing opioids without medical justification.
Issue:
Whether running a pill mill constitutes prescription drug fraud and distribution.
Holding:
The court upheld convictions for conspiracy and distribution under the Controlled Substances Act.
Significance:
Highlights targeting of illegal “pill mills” by federal prosecutors.
Case 5: United States v. Foster, 624 F.3d 666 (4th Cir. 2010)
Facts:
Foster was charged with forging prescriptions and distributing controlled substances.
Issue:
Whether forging prescriptions for controlled substances violates federal law.
Holding:
The court affirmed conviction, emphasizing the illegality of using forged prescriptions to obtain controlled drugs.
Significance:
Confirms forgery of prescriptions as a key offense in prescription drug fraud prosecutions.
Case 6: United States v. Ruan, 966 F.3d 1101 (11th Cir. 2020)
Facts:
Ruan, a pain management doctor, was prosecuted for prescribing opioids beyond the bounds of professional practice.
Issue:
Whether “legitimate medical purpose” is judged by the doctor’s subjective intent or objective standards.
Holding:
The 11th Circuit ruled that the government must prove the doctor lacked a legitimate medical purpose objectively, emphasizing fair notice and due process.
Significance:
Important for setting standards in prosecuting medical professionals under prescription drug laws.
Case 7: United States v. Hagerman, 555 F.3d 1069 (10th Cir. 2009)
Facts:
Hagerman was convicted for doctor shopping and using multiple false prescriptions.
Issue:
Whether doctor shopping to obtain controlled substances violates federal law.
Holding:
Court upheld convictions, confirming that multiple prescriptions obtained fraudulently constitute prescription drug fraud.
Significance:
Emphasizes prosecution of individuals who abuse multiple prescribers to acquire drugs illegally.
5. Summary Table
| Case Name | Legal Principle | Significance |
|---|---|---|
| United States v. Moore | Doctors liable if prescribing without legit purpose | Sets limits on medical discretion |
| United States v. Angelilli | Overlapping healthcare and prescription fraud | Shows prosecutorial strategies |
| United States v. Ghanem | No legit medical purpose = violation | Confirms prosecution of non-medical prescribing |
| United States v. Patel | Pill mills prosecuted as drug distribution | Targets illegal prescribing operations |
| United States v. Foster | Forging prescriptions is a crime | Reinforces prescription forgery as offense |
| United States v. Ruan | Objective standard for medical legitimacy | Protects doctors with legitimate practice |
| United States v. Hagerman | Doctor shopping is illegal | Penalizes fraudulent multi-prescription schemes |
6. Conclusion
Prescription drug fraud prosecutions rely on demonstrating intentional deception or illegitimate prescribing practices, often under multiple overlapping statutes. Courts emphasize protecting public health while ensuring medical professionals retain fair legal standards. The crackdown on opioid-related prescription fraud has led to numerous high-profile prosecutions and evolving legal standards.
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