Denis Mikhlin of St. Louis conspired with Dr. Jerry Leech and others to issue and distribute illegal prescriptions for opioids and other controlled substances to patients. Mikhlin and his co-conspirators knew the patients did not have a legitimate medical need for drugs and instead were abusing them or selling them. Mikhlin recruited individuals and paid them for the use of their names on the fraudulent prescriptions. Mikhlin pleaded guilty to four felony counts of conspiracy, obtaining oxycodone and other opioid drugs by fraud and deceit, receiving illegal kickbacks in return for sending urine specimens to Central Diagnostic Laboratory for medically unnecessary testing, and causing the Medicare and Medicaid programs to pay $4,704,568 for medically unnecessary prescription drugs and drug tests.