Opioid Epidemic Trends and Insights: Law Enforcers are Expanding and Transforming Their Toolbelts to Hold Anyone and Everyone Accountable for this National Emergency

Opioid Civil Litigation Efforts and their Impact

The only major case to advance to trial was brought in August 2019 by the state of Oklahoma against Johnson & Johnson.  Judge Thad Balkman stated that the company’s “misleading marketing and promotion of opioids created a nuisance as defined by [the law].”³ Specifically, Johnson & Johnson was found to have intentionally misled the public by knowingly overselling the benefits and downplaying the risks of opioid use. Judge Balkman ultimately ordered the company to pay the state $465 million to fund state opioid crisis recovery efforts.⁴ This number is far below the $17.5 billion originally sought by Oklahoma, and is estimated to cover only one year of the state’s opioid recovery plans.⁵ The company stated it plans to appeal the judgment, but the verdict itself may foreshadow pending opioid litigation outcome potential for the various implicated industry players.⁶

The largest litigation effort in progress is the aptly named “National Prescription Opiate Litigation.”⁷ Originally 2,500 individual suits brought by state and local enforcement agencies against nearly every actor in the opioid value stream, the cases were consolidated and placed under Judge Dan Aaron Polster in the Northern District of Ohio. Collectively, the plaintiffs allege that “manufacturers of prescription opioids grossly misrepresented the risks of long-term use of those drugs for persons with chronic pain, and that distributors failed to properly monitor suspicious orders of those prescription drugs — all of which contributed to the current opioid epidemic.”⁸

Defendants, including powerhouses like CVS and McKesson Corporation, are sorted into four general categories: Manufacturer-Defendants; Distributor-Defendants; Physician-Defendants; and Chain-Pharmacy defendants. By grouping defendants with similar roles in the epidemic, courts avoid thousands of individual trials, ultimately expediting the litigation. Whether this is good or bad for either party remains to be seen.

Learning from the outcome in the Johnson & Johnson judgment in Oklahoma,⁹ pharmaceutical companies seem more willing to enter a settlement agreement rather than risk a full trial and severe verdict. The first bellwether trial for the National Prescription Opiate Litigation was set to begin in October 2019.¹⁰ (For reference, a bellwether trial is when a small number of cases are separated from a larger litigation effort to be a test case for predicting the result(s) in a grander litigation effort). The bellwether trial at issue here was expected to reveal how the remaining pharmacy litigation might play out. Nonetheless, merely two days prior to trial, a last-minute settlement was reached by the bellwether parties. Teva Pharmaceuticals, AmerisourceBergen, McKesson Corporation, and Cardinal Health agreed to a $260 million settlement with two Ohio Counties.¹¹

Following this bellwether trial settlement, Judge Polster announced that the next trial against major pharmacy defendants, including CVS and Rite-Aid, is set for October 2020.¹²

Judge Polster additionally issued an order on November 19, 2019, stating that if the court “proceeds with the bellwether trial process as it has so far, it will simply take too long to reach each category of plaintiff and defendant, much less each individual plaintiff and defendant.”¹³ To hasten the process he deviated from the original trial plan and “strategically remanded” three separate cases to other federal courts.¹⁴ These remands will likely force the defendants to advance their legal arguments in court or agree to large settlements.¹⁵ Judge “Polster has long said he wants to see a global settlement” of all of the claims, and these “strategic remands” are a means to that end.¹⁶ Following the strategic remands, on February 25, 2020 opioid manufacturer Mallinckrodt  announced a global settlement in principle with “attorneys general for all 47 states and US territories” for $1.6 billion.¹⁷

Another settlement is likely to come from Purdue Pharma (Purdue). Purdue, maker of OxyContin (a powerful opioid) and Narcan (a drug that can reverse effects of opioid overdose), is a major player in the National Prescription Opiate Litigation.¹⁸ The plaintiffs allege that Purdue "misrepresented the risk of addiction from long-term use, claimed that long-term opioid use is safe and effective, and paid ‘key opinion leaders’ to encourage opioid use.”¹⁹ In September 2019 Purdue reached a settlement agreement in principle with “24 state attorneys general, analogous officials from 5 U.S. territories, the Plaintiffs’ Executive Committee in the multidistrict litigation (MDL), and co-lead counsel in the MDL.”²⁰ The agreement involved Purdue filing for Chapter 11 bankruptcy and promising approximately $10 billion in value “for the benefit of the American public.”²¹

As part of the proceedings, Bankruptcy Judge Robert Drain temporarily shielded Purdue from all lawsuits brought by entities not involved in the settlement agreement.²² The seven month stay, set to expire on April 8, 2020, was intended to facilitate further settlement negotiations and to prevent draining of company resources.²³ To date, no new settlements have been reached, so all cases brought by the two dozen states who opposed, or did not participate in, the September settlement agreement in principle will resume on expiration of the stay.²⁴

Outside of the National Prescription Opiate Litigation and bankruptcy proceedings, Purdue could soon be facing additional charges related to an illegal kickback scheme.²⁵ Court filings brought by federal prosecutors in Vermont allege that a company, Pharma Co. X, “[paid] kickbacks to Practice Fusion, now a unit of Allscripts Healthcare Solutions Inc, to develop an alert used in physicians’ software with the goal of boosting its opioid product sales.”²⁶ The software prompted physicians to frequently ask about their patients’ pain levels, and suggested the use of opioid treatment therapies.²⁷ On January 28, 2020 Reuters revealed that Purdue is Pharma Co. X.²⁸ No formal charges have been filed against Purdue to date and Purdue claims it is working with the Justice Department investigators. Given the high volume and variety of legal issues facing Purdue, continued monitoring of its actions is critical.

Criminal Accountability for Companies, Executives, and Pill Mills

Outside major civil litigation, the Drug Enforcement Administration (DEA), alongside state enforcement officials, is aggressively pursuing criminal actions in an effort to stem the epidemic. They have recently brought unprecedented charges against companies and their executives individually and held individual providers and pharmacies liable for “pill mill” schemes, as further explained below.

In April 2019 the DEA brought the first criminal charges against a major criminal drug distributor and its executives individually. The DEA charged Rochester Drug Co-Operative and its executives with three crimes, including unlawful distribution of controlled substances, conspiracy to defraud the DEA, and knowingly failing to comply with the company’s legal obligation to report “thousands of suspicious orders of controlled substances to the DEA.”²⁹ This was the first major case to attack individual executives, treating the “white collar executives. . . like street dealers and traffickers.”³⁰ The company has since entered into a five-year deferred prosecution agreement with the federal government and agreed to pay a $20 million fine.³¹ Laurence Doud, former Chief Executive Officer, has pled not guilty to two criminal counts and is scheduled for trial in May 2020. Meanwhile, the Rochester Drug Co-Operative’s former Chief Compliance Officer William Pietruszewski pled guilty to three criminal counts.

The DEA and state officials have not stopped at key player accountability: they are also aggressively pursuing actions against individual providers and pharmacies. The most common criminal opioid scheme is referred to as “pill mill.” Pill mills are characterized by inordinately high numbers of prescriptions and (frequently) cash-only operations. The most common charge for pill mill prosecution is conspiracy to unlawfully dispense and distribute controlled substances.³² Consequences include not only severe fines, but also heavy prison sentences.

For example, in March 2018 a Houston physician, who used a pain management clinic as a pill mill, was found to have unlawfully written an estimated 18,252 prescriptions of hydrocodone and roughly 15,649 prescriptions for carisoprodol in a two-year period.³³ Both the physician and the pain management clinic owner were sentenced to 35 years in prison for the scheme.³⁴ In August 2019, a DEA bust resulted in the arrest of 40 people for running a pill mill using an elaborate network of providers, pharmacies, clinics, drug dealers and traffickers. As a result of the scheme, over 23 million doses of opioids were diverted.³⁵

Finally, in September 2019 federal charges were brought across all four districts of Texas against 58 people — including seven doctors and six pharmacists — for running an extensive pill mill network out of a Houston, Texas based pharmacy.³⁶  In total, the pharmacy distributed more than 760,000 pills in less than 18 months by using “counterfeit prescription pads. . . [and using runners to bring] illegitimate prescriptions to them to be filled for cash-only – all the while charging nearly five times the market value for equivalent oxycodone and hydrocodone prescriptions.”³⁷ The Healthcare Fraud Unit and Medicare Fraud Strike Force, a “partnership among the Criminal Division, U.S. Attorney’s Offices, FBI, Health and Human Services-Office of Inspector General (HHS-OIG) and the Drug Enforcement Administration (DEA),” alleges that the Texas pill mill network accepted over $66 million in fraudulent reimbursement from government payors.³⁸ Both of the 2019 Texas cases are pending, but if previous litigation is any indication, the individuals and entities involved will likely face significant prison time and hefty fines.

Criminal Liability of Providers for Patient Injury and Death

Charges relating to illegal pill mill schemes are continuing to increase in scope to include criminal charges related to injury and death of patients. One of the most widely publicized prosecutions was against Florida physician Dr. Barry Schultz, who once prescribed over 1,000 pills to a pregnant woman.³⁹ Dr. Schultz was found guilty of manslaughter for the overdose death of another patient when a jury found that the death was caused by his over-prescription of opioids. He was also found guilty of drug trafficking and originally sentenced to 25 years in prison. This sentence was increased to 157 years in 2018 when a state appeals court determined the original sentence was too lenient.

One year later, federal prosecution of a West Virginia pill mill garnered national attention when a primary care physician, Dr. Joel Smithers, was convicted for over 800 drug-related offenses and the overdose death of a patient related to his pill mill operation and over-prescription of opioids. Dr. Smithers collected nearly $700,000 in cash from his patients, often had waiting lines in excess of 12 hours, and wrote the highest number of opioid prescriptions per person in the United States.⁴⁰ Dr. Smithers was fined $86,000 and sentenced to 40 years in prison. Twenty of those years are directly attributed to the overdose death of a patient caused by his over-prescription of opioids.⁴¹

Some states are pursuing even more extreme actions, expanding the scope of criminal charges against individual providers to include murder and elder abuse allegations. In August 2019, Dr. Robert Keller, a neurologist and pain management physician, was charged by a California court with felony murder, elder abuse, and issuing prescriptions without a legitimate medical purpose.⁴² Between 2011–2017, the state alleges he engaged in consistent unreasonable prescription increases; a pattern of prescribing maximum amounts of pills; and a history of ignoring warnings from pharmacies. Dr. Keller pled not guilty to all charges and has remained in jail since his August arrest.⁴³ His trial began in January 2020 and it is expected to last approximately two months.⁴⁴

The Schultz, Smithers, and Keller cases represent a totally new angle of attack against individual providers. All three physicians were charged with crimes related to the way in which they prescribed medication. The allegations of illegal prescribing behavior brought against physicians are decidedly different from the usual pill mill charges because they seemingly challenge actions that are normally considered the practice of medicine. The practice of medicine is traditionally governed by the state boards of medicine. While criminal charges like these are not unprecedented,⁴⁵ they are still rare. These cases could illustrate a new form of liability that health law attorneys should reasonably anticipate.

Practitioner Takeaways

It is quickly becoming clear that action against pharmaceutical distributors, manufacturers, providers, executives, and prescribers is progressing rapidly. There are several key takeaways for health law and litigation attorneys related to the increase in frequency and severity of opioid enforcement against those connected to the pharmaceutical industry.

First, traditional enforcement activities are expanding. Federal law enforcement is increasingly looking to alternative options for opioid epidemic accountability, rather than solely relying upon traditional mechanisms, like the False Claims Act⁴⁶ or the Anti-Kickback Statute.⁴⁷ For instance, criminal statutes typically reserved for illegal drug distributors are now being wielded against pharmaceutical distributors and their executives, as seen in the Rochester Drug Co-Operative prosecution. Further, the West Virginia Smithers case shows that individuals involved in perpetuating the epidemic are now being held accountable for not just illegal distribution and fraud, but unlawful killings.

The most stunning expansion is the allegation of unreasonable prescription increases and patterns. As noted earlier, these allegations are distinct because they intrude on the regulation of the practice of medicine. Physicians, like lawyers, are a primarily self-regulated profession. Peer review boards, hospital medical staff committees, quality committees, professional associations, and the National Practitioner Data Bank are all intended to uphold professional standards and identify and publicize any professionals who fall below those standards. It is unclear what effect exposing providers to criminal liability for the “unreasonable practice of medicine” may have on the medical profession, individual practice, and, ultimately, patient care. Attorneys should be aware of the potential for these charges and counsel clients accordingly.

Second, new enforcement tools are emerging to maximize responsibility for illegal compensation incentive schemes. In October 2018, Congress passed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act⁴⁸ (SUPPORT Act). The SUPPORT Act is intended to tackle the opioid epidemic from all angles, addressing both treatment and prevention. As part of the SUPPORT Act, Congress also enacted the Eliminating Kickbacks in Recovery Act (EKRA). EKRA criminalizes the knowing and willful solicitation, receipt, payment, or offer of payment, direct or indirect, for patient referrals to recovery homes, clinical treatment facilities, or laboratories when the services are covered by a healthcare benefit program.

EKRA is often criticized as being too broad. For example, the Anti-Kickback Statute is only implicated when a federal benefit program is involved. In contrast, the term “healthcare benefit program” under EKRA extends the statute’s reach to both private and government payors. This expansion reveals an aggressive approach to hold more individuals involved in the opioid epidemic fully accountable. In fact, the first successful prosecution under EKRA occurred in January 2020. Theresa Merced, an 80-year old manager of a substance abuse treatment center in Jackson, Kentucky, pled guilty to violating EKRA when “she solicited kickbacks from a toxicology laboratory in exchange for urine drug testing referrals.”⁴⁹ She now “faces up to 20 years in prison and a maximum fine of $250,000.”⁵⁰ Expect the Merced case to be the first of many actions brought under EKRA’s broad provisions.

Third, understanding the adjudication structure could be significant for litigation outcomes. As seen in the National Prescription Opiate Litigation, courts are categorizing defendants and bifurcating trials accordingly. Categorization of defendants could impact strategic decision making and the amounts paid out in settlements, penalties, and assessments. From a structural perspective, attorneys must be acutely aware of the posture of the litigation, the number of defendants, likelihood of trial bifurcation, and their own client’s position in the midst of the chaos. Further, understanding the role each person plays in the opioid epidemic might impact the enforcement theory, and thus the scope of their client’s liability. It is evident that enforcement efforts can and will reach anyone involved in perpetuating the opioid epidemic. Pharmaceutical actors are all exposed to liability if their activity falls within reach of the many available enforcement tools.

Finally, attorneys must synthesize current opioid prosecution activity, litigation outcomes, and judicial reasoning to help develop preventative and educational compliance tools for any clients involved (even tangentially) with opioids. Attorneys must continue to consider how organizations can best create, implement, and monitor internal controls that target opioid misuse and abuse. In-house counsel should review and revise organizational policies related to opioids. For providers, evaluation of diversion controls, allowable prescribing practices, pharmacy distribution, and technology system alerts related to dosing will be critical. For pharmaceutical manufacturers and distributors, it will be useful to conduct an evaluation of marketing practices, set alerts for unjustifiable distribution effort increases, and develop educational materials on the benefits and pitfalls of opioid use. Compliance is the first step towards addressing the United States’ grander opioid problem. Establishing an appropriate compliance framework is mission critical for the future of healthcare practice and patient safety.

1. What is the U.S. Opioid Epidemic?, U.S. Dep’t of Health & Hum. Serv., https://www.hhs.gov/opioids/about-the-epidemic/index.html (last reviewed Sept. 4, 2019).
2. Howard, J. & Drash, W., Oklahoma Wins Case Against Drugmaker in Historic Trial, CNN (Aug. 27, 2019), https://www.cnn.com/2019/08/26/health/oklahoma-opioid-trial-verdict-bn/index.html.
3. Lovelace, B., Judge Rules Against Johnson & Johnson in Landmark Opioid Case in Oklahoma, CNBC (Aug. 26, 2019), https://www.cnbc.com/2019/08/26/judge-rules-against-johnson-johnson-in-landmark-opioid-case-in-oklahoma.html.
4. Randazzo, S., Johnson & Johnson’s Oklahoma Opioid Penalty Reduced to $465 Million, Wall Street J. (Nov. 15, 2019), https://www.wsj.com/articles/johnson-johnsons-oklahoma-opioid-penalty-reduced-to-465-million-11573854343.
5. Fortier, J. & Mann, B., Johnson & Johnson Ordered to Pay Oklahoma $572M in Opioid Trial, NPR (Aug. 26, 2019), https://www.npr.org/sections/health-shots/2019/08/26/754481268/judge-in-opioid-trial-rules-johnson-johnson-must-pay-oklahoma-572-million.
6. Dwyer, C. & Fortier, J., Oklahoma Judge Shaves $107 Million Off Opioid Decision Against Johnson & Johnson, NPR (Nov. 15, 2019), https://www.npr.org/2019/11/15/779439374/oklahoma-judge-shaves-107-million-off-opioid-decision-against-johnson-johnson (“Lawyers for Johnson & Johnson say they will appeal the ruling.”).
7. See Dwyer, C., Your Guide to the Massive (and Massively Complex) Opioid Litigation, NPR (Oct. 15, 2019), https://www.npr.org/sections/health-shots/2019/10/15/761537367/your-guide-to-the-massive-and-massively-complex-opioid-litigation.
8. In re National Prescription Opiate Litigation, No. 1:17-MD-2804 (N.D. Ohio 2017), https://www.ohnd.uscourts.gov/mdl-2804.
9. The lawsuit in Oklahoma was brought by state government officials separately from the National Prescription Opiate Litigation. Dwyer, supra n. 7. Johnson & Johnson subsequently settled with two Ohio Counties as part of the National Prescription Opiate Litigation. Neumann, S., In Opioid Settlement, Johnson & Johnson Agrees to Pay Ohio Counties $20 Million, NPR (Oct. 2, 2019), https://www.npr.org/2019/10/02/766332253/in-opioid-settlement-johnson-johnson-agrees-to-pay-ohio-counties-20-million.
10. Dwyer, supra n. 7.
11. Dwyer, supra n. 7.
12. Bernstein, L., Pharmacy Chains Face October 2020 Trial Over Their Role in the Opioid Crisis, Wash. Post (Nov. 19, 2019), https://www.washingtonpost.com/health/pharmacy-chains-face-october-2020-trial-over-their-role-in-the-opioid-crisis/2019/11/19/61666ee4-0b1b-11ea-bd9d-c628fd48b3a0_story.html.
13. Suggestions of Remand, In re National Prescription Opiate Litigation, No. 1:17-MD-2804 (N.D. Ohio 2019), https://www.ohnd.uscourts.gov/sites/ohnd/files/2941.pdf (emphasis in the original).
14. Id. Judge Polster suggested remand of the following three cases to their respective transferor courts: City and County of San Francisco, Cal., et al. v. Purdue Pharma L.P. et al. (N.D. Cal), City of Chicago v. Purdue Pharma L.P. et al. (N.D. Ill.), and Cherokee Nation v. McKesson Corp. et al. (E.D. Okla.).
15. Overley, J., Opioid MDL Judge Plots New Bellwether Trials Across US, Law 360 (Nov. 19, 2019), https://www.law360.com/articles/1221570/opioid-mdl-judge-plots-new-bellwether-trials-across-us.
16. Zezima, K., Ohio Tries an Unusual Tactic Toward Opioid Settlement: Working Together, Wash. Post (Feb. 24, 2020), https://www.washingtonpost.com/national/ohio-tries-an-unusual-tactic-toward-opioid-settlement-working-together/2020/02/24/d5923faa-4c48-11ea-9b5c-eac5b16dafaa_story.html.
17. Schuman, M. & Jackson, A., Opioid Manufacturer Reached Proposed $1.6 Billion Settlement, CNN (Feb. 27, 2020), https://www.cnn.com/2020/02/25/health/mallinckrodt-opioid-settlement-trnd/index.html.
18. Orden, E., Purdue Pharma Sought Secret Plan to Become ‘End-to-End Pain Provider,’ Lawsuit Alleges, CNN (Jan. 31, 2019), https://www.cnn.com/2019/01/31/health/purdue-pharma-unredacted-lawsuit/index.html.
19. Berry, M. D,, Holding Them Accountable: Targeting Opioid Manufacturers and Pill Mill Doctors in the Fight Against Healthcare Fraud, Thomson Reuters: Legal Executive Institute (Dec. 7, 2018), http://www.legalexecutiveinstitute.com/opioid-manufacturers-pill-mill-doctors/.
20. Purdue Pharma Announces Settlement in Principle on Landmark Opioid Litigation Settlement, Purdue Pharma (Sept. 16, 2019), https://www.purduepharma.com/news/2019/09/16/purdue-pharma-announces-agreement-in-principle-on-landmark-opioid-litigation-settlement/.
21. Hals, T., Judge Shields OxyContin-Maker Purdue from Litigation Until April, Reuters (Nov. 6, 2019), https://www.reuters.com/article/us-purdue-pharma-bankruptcy/judge-shields-oxycontin-maker-purdue-from-litigation-until-april-idUSKBN1XG32O.
22. Feeley, J., & Church, S., OxyContin Maker Purdue Pharma Files for Bankruptcy to Wipe Out 2,000 Lawsuits, Bloomberg (Sept. 16, 2019), https://www.bloomberg.com/news/articles/2019-09-16/purdue-pharma-seeks-bankruptcy-to-short-circuit-opioid-suits-k0luhox6.
23. Merle, R., Judge in Purdue Pharma Bankruptcy Case Extends Lawsuit Protection to Sacklers, Wash. Post (Nov. 6, 2019), https://www.washingtonpost.com/business/2019/11/06/judge-purdue-pharma-bankruptcy-extends-lawsuit-protection-sacklers/.
24. Hals, T., Where the Purdue Pharma-Sackler Saga Stands, Reuters (Jan. 29, 2020), https://www.reuters.com/article/us-purdue-pharma-bankruptcy-factbox/where-the-purdue-pharma-sackler-legal-saga-stands-idUSKBN1ZS1H3.
25. Id.
26. Id.
27. Farzan, A. N., A Tech Company Gave Doctors Free Software – Rigged to Encourage Them to Prescribe Opioids, Prosecutors Say, Wash. Post (Jan. 28, 2020), https://www.washingtonpost.com/nation/2020/01/28/opioid-kickback-software/.
28. Id.
29. 21 U.S.C. § 802(6); 21 C.F.R. § 1308.12; 21 C.F.R. § 1301.74(b). Manhattan U.S. Attorney and DEA Announce Charges Against Rochester Drug Co-Operative and Two Executives for Unlawfully Distributing Controlled Substances, U.S. Dep’t of Just. (Apr. 23, 2019), https://www.justice.gov/usao-sdny/pr/manhattan-us-attorney-and-dea-announce-charges-against-rochester-drug-co-operative-and.
30. Katersky, A. & Youn, S., Feds Charge Rochester Drug Cooperative and CEO in First Criminal Case Over Opioids, ABC News (Apr. 23, 2019), https://abcnews.go.com/US/drug-executive-laurence-doud-iii-arrested-opioids/story?id=62575543.
31. Letter from Geoffrey S. Berman, United States Attorney, S.D.N.Y., to Douglas B. Farquhar, Att’y for Rochester Drug Coop. (Apr. 22, 2019), https://www.justice.gov/usao-sdny/press-release/file/1156381/download (providing the Deferred Prosecution Agreement).
32. 21 U.S.C. § 846.
33. Houston Physician and Pain Management Clinic Owner Convicted of Running “Pill Mill” that Provided Unlawful Prescriptions for Millions of Doses of Opioids and Other Controlled Substances, U.S. Dep’t of Just. (Mar. 28, 2018), https://www.justice.gov/opa/pr/houston-physician-and-pain-management-clinic-owner-convicted-running-pill-mill-provided. See also Berry, supra n. 19.
34. Houston Physician and Pain Management Clinic Owner Each Sentenced to 35 Years in Prison for Running Pill Mill That Provided Unlawful Prescriptions for Millions of Doses of Opioids and Other Controlled Substances, U.S. Dep’t of Just. (Sept. 20, 2018), https://www.justice.gov/opa/pr/houston-physician-and-pain-management-clinic-owner-each-sentenced-35-years-prison-running.
35. Charges Filed Against Dozens in Trafficking Network Responsible for Diverting Over 23 Million Oxycodone, Hydrocodone, and Carisoprodol Pills, U.S. Dep’t of Just. (Aug. 28, 2019), https://www.justice.gov/opa/pr/charges-filed-against-dozens-trafficking-network-responsible-diverting-over-23-million.
36. Texas Health Care Fraud and Opioid Takedown Results in Charges Against 58 Individuals, U.S. Dep’t Just. (Sept. 18, 2019), https://www.justice.gov/opa/pr/texas-health-care-fraud-and-opioid-takedown-results-charges-against-58-individuals.
37. Brian Benczkowski, Assistant Attorney General Brian A. Benczkowski Gives Remarks at the Texas Healthcare Fraud and Opioid Takedown Press Conference, U.S. Dep’t Just. (Sept. 18, 2019), https://www.justice.gov/opa/speech/assistant-attorney-general-brian-benczkowski-gives-remarks-texas-healthcare-fraud-and.
38. Texas Health Care Fraud and Opioid Takedown Results in Charges Against 58 Individuals, supra n. 36.
39. Bill Whitaker, Who’s Responsible for the Opioid Epidemic? Doctors or Pharmaceutical Companies?, CBS News (Aug. 25, 2019), https://www.cbsnews.com/news/jailed-doctor-barry-schultz-interview-opioid-epidemic-60-minutes-2019-08-25/.
40. Booker, B., Doctor Gets 40 Years for Illegally Prescribing More than Half a Million Opioid Doses, NPR (Oct. 2, 2019), https://www.npr.org/2019/10/02/766403612/doctor-gets-40-years-for-illegally-prescribing-more-than-half-a-million-opioid-d.
41. Id.
42. Complaint, People v. Keller, No. SCR-730100-1 (Cal. Super. Ct.) (2019).
43. Johnson, J., Murder Trial Begins for Santa Rosa Doctor Accused of Overprescribing Opioids, Press Democrat (Jan. 29, 2020), https://www.pressdemocrat.com/news/10643995-181/murder-trial-against-santa-rosa.
44. Id.
45. E.g., Duntsch v. State, 568 S.W.3d, 193 (2018) (Tex. App.—Dallas, pet. ref'd) (Surgeon, commonly known as “Dr. Death” was convicted of elderly abuse tied to a long pattern of death and paralysis of his patients).
46. 31 U.S.C. § 3729.
47. 42 U.S.C. § 1320a–7b(b).
48. Support for Patients and Communities Act of 2018, Pub. L. No. 115-271, 132 Stat. 3894.
49. Jackson Woman Pleads Guilty to Soliciting Kickbacks, Making False Statements to Law Enforcement Agents, and Tampering with Records, U.S. Dep’t of Just (Jan. 10, 2020), https://www.justice.gov/usao-edky/pr/jackson-woman-pleads-guilty-soliciting-kickbacks-making-false-statements-law.
50. Id.