The Difference Between Pill Mills and Pain Mills

Categories: Medicare Lawyer

pill mill

Why Professionals Working for Pain Clinics Must Now Worry About Criminal Charges

You know something is becoming a big issue when media outlets begin using a special term for it.

For years, we’ve all been hearing about pill mills on the five o’clock news. These are clinics where doctors issue an alarming number of prescriptions for pain-killing medications to patients who may or may not need them.

The patients are there to feed an addiction or to upsell the opioids on the black market. The doctors are there to willingly turn a blind eye and make a few bucks on the side. Sometimes, it’s the bulk of their business. The nurses and billing coordinators might even be in on it. And footing the bill for the whole racket are the insurance companies, Medicare, Medicaid, and so on.

Or at least that’s the picture painted by the DOJ through press announcements and in criminal indictments.

Just about any type of doctor’s office can be accused of operating as a pill mill, from the family physician to the local dentist. But when the medical practice in question is a pain clinic, scrutiny might develop more quickly.

Why? Well, the most common prescriptions coming out of pain clinics are, unsurprisingly, for potent painkillers. So, there is a certain logic in putting those clinics under the microscope, hoping to more quickly identify ones that might be operating as pain mills (that is, a pain clinic accused of functioning as a pill mill).

What does this mean for you if you’re currently employed by a pain clinic — or do business with one?

Be cautious. Be proactive. Take audits seriously. Be mindful of the possibility that a criminal investigation could come at any time. Know that mounting drug abuse means a simultaneous increase in pain mill investigations. Don’t hesitate to ask an experienced attorney for advice on compliance and strategies for avoiding criminal charges.

Potential Criminal Charges Facing Accused Pill Mills

The legal consequences of a pill mill investigation can range from civil penalties to imprisonment, and the findings might implicate any number of state or federal statutes. Some of the most commonly cited criminal infractions include:

  • Health care fraud (e.g., overbilling an insurer or sending the wrong billing codes to the CMS)
  • False Claims Act violations
  • Conspiracy to defraud
  • Controlled Substances Act violations
  • Stark Law violations
  • Anti-kickback law violations
  • Mail fraud
  • Wire fraud
  • Bank fraud

These offenses can lead to staggering financial penalties, CMS prepayment review penalties, loss of medical licenses and/or DEA registration, ethics complaints with your state licensing board, or even years in prison.

What Pain Clinics Should Look for in a Pain Mill Investigation

Frighteningly enough, your pain clinic could be under investigation as a pain mill right now without your knowledge. That’s why anyone who is involved in prescribing painkillers, submitting frequent claims to CMS, or who has handled a recent billing dispute with the government or a private insurer should take every precaution to comply with the law.

While there is no way to know for sure, signs of a pain mill investigation might include:

  • Patients making suspicious or unusual statements to you during an appointment, such as asking for painkillers by their street name, or going out of their way to tell you they live in another state or that they’ve already asked other doctors for painkillers too. These could be undercover agents participating in a sting operation.
  • Patients asking to pay in cash for painkillers.
  • Signs of surveillance in or around your office.
  • Government requests for your PDMP records
  • Recent litigation, investigations, or criminal charges involving someone who has worked with or for your clinic
  • Any notice of an audit, investigation, or review

If you’ve noticed any of these occurrences, we urge you to contact an experienced pain mill case defense attorney right away.

Hiring the Right Law Firm Can Change the Outcome of Your Pain Mill Investigation

Health care fraud and related criminal matters demand substantive, hands-on experience in cases of a similar nature.

It is our belief that these legal matters are usually too complex — and the stakes are too high — for care providers to take a gamble on an attorney who hasn’t handled numerous cases in this same practice area before (both in negotiation and at trial).

At Oberheiden, P.C., our priorities in every case are:

  • Avoiding indictments, criminal prosecutions, and incarceration
  • Making sure you keep your license and stay in practice
  • Minimizing the impact of any investigation or audit (something we’re often able to achieve through negotiation and practical legal strategies)

While we always prefer to get involved in a case as early as possible, we have been able to avoid charges for many our clients even after an investigation had already begun.

Our legal team includes several former federal health care fraud prosecutors. By drawing on their vast experience and insight from working for the feds, they also know how to present the truth, and convincingly argue to care investigators that the conduct they’re investigating is simply a human error, and that prosecutors will not be able to meet their burden of proof in court to demonstrate that it constitutes fraud.  

We have even been successful in bringing to a close various OIG and grand jury investigations into individual doctors, physician syndications, health care businesses, and other medical providers — without criminal prosecution.

If your practice has been accused of operating as a pain mill, you deserve to have meaningful experience on your side.

Contact a Pain Mill Case Defense Attorney at Oberheiden, P.C. Right Away

We are federal law firm that offers professional and business owners across the nation free and confidential consultations in health care criminal matters. The sooner we can get involved, the better. Please contact us right away.

Oberheiden, P.C.
Compliance – Litigation – Defense
(888) 356-4634
Medicare-Lawyer.com
This information has been prepared for informational purposes only and does not constitute legal advice. This information may constitute attorney advertising in some jurisdictions. Merely reading this information does not create an attorney-client relationship. Prior results do not guarantee similar outcomes in the future, every case is different. Oberheiden, P.C. is a Texas firm with its headquarters in Dallas. Mr. Oberheiden limits his practice to federal law.
Pain Mill Defense Lawyers – Oberheiden, P.C.