Trace the Pill

The medical profession has been experiencing an image problem for some time though it seems it has been getting worse.

When I was a kid, doctors were very well respected, intellectually superior members of society seen as above reproach because they saved lives.

My uncle was a physician.

My dad was a dentist.

I grew up admiring these professionals and their colleagues who spent so much of their lives learning, teaching, healing, looking after mankind and making sacrifices to better the human race.

Now it seems that these professionals get no respect, or at least not the amount or kind of respect that existed when I was a kid.

There are fee schedules restricting what can be billed for. There are practice guidelines dictating what can be performed. There are utilization reviews and independent reviews second guessing medical decisions.

And then there are the folks that just end up corrupted by the money and heaping further bad image upon an already targeted group.

Drugs provide an incredible source of corruption motivation - just follow the money.

The U.S. Attorney's Office announced the other day that a federal jury last week convicted two South Florida doctors of conspiracy to commit money laundering in connection with an investigation of pain clinics operating as "pill mills" in Broward and Palm Beach counties.

U.S. Attorney Wilfredo A. Ferrer, along with others connected to the investigation, said in a press release that a West Palm Beach, Fla., jury ended a two-month trial last week and convicted Dr. Cynthia Cadet, 43, of Parkland, Fla., and Dr. Joseph Castronuovo, 73, of Key Largo, Fla.

Sentencing has been scheduled for Nov. 4, 2013, before U.S. District Court Judge Kenneth A. Marra.

In August 2011, a federal grand jury indicted Cadet, Castronuovo and 30 other defendants targeted in Operation Oxy Alley, a federal/state probe of pill mills. Twenty-eight defendants have entered guilty pleas and been sentenced in the case.

According to the August 2011 indictment and a superseding indictment, Christopher and Jeffrey George, twin brothers, operated and managed four pain-management clinics that distributed an estimated 20 million oxycodone pills from 2007 to early 2010.

Prosecutors said the scheme made more than $40 million from the illegal sales and distribution of controlled substances. Thirteen of the 32 defendants were doctors.

The George brothers were highlighted in an article published in Bloomberg Businessweek last year.

It notes that the pain clinics the Georges established didn't discriminate against pain patients - if you went in, you came out with pills.

And each operation was bigger than the other.

Christopher George even invested in pharmacies and opened clinics in Georgia, Missouri and Texas.

From 2008 to 2010, according to the federal agents, the George twins were the largest illegal dispensers of oxycodone in the U.S.

In the fall of 2011, Jeffrey George pleaded guilty to one count of racketeering conspiracy and is serving a 15½-year sentence.

Christopher George pleaded guilty to one count of racketeering conspiracy and is serving 17½ years in prison. The twins’ mother, Denice Haggerty, pleaded guilty to one count of conspiracy to commit wire fraud and received a 30-month sentence.

What do the George twins have to do with bad doctors?

Christopher's interview with Businessweek gives a clue: he says not a single doctor ever turned down a job offer. "The hours were good. The pay was good.”

The pay was really good.

Doctors at Georges' clinics were paid a flat fee for each opioid prescription they wrote—typically, $75 to $100 for each prescription. To maximize efficiency, doctors were given prescription stamps they could use quickly, over and over.

It was common for physicians at one of Georges' clinics, American Pain, to see 100 patients a day, according to the interview. Extrapolated, a doctor would earn roughly $37,500 a week—or $1.95 million a year, directly dispensing medication.

The Georges made their money in part by charging patients consultation fees of $200 for the first visit, and $150 for each visit thereafter. They made another part of their profits by buying drugs wholesale (they had to do a lot of work to find wholesalers that could meet the demand and do so with minimal restrictions) and marking them up, sometimes dramatically as we have seen in the workers' compensation system, in direct physician dispensing.

The interview with Christopher George is fascinating to me because it is classic anti-social behavior.

He says he was targeted for doing nothing wrong - he followed the law and the law was loose so he profited from it. And he admits that as the law was tightened, then moving to another jurisdiction where the law was still loose provided for continued business operations.

“Really there’s no way to stop someone from getting pain medication,” says George. “If you limit it because there are drug addicts out there, you’re going to hurt the people who really need it. People are good liars. They can say they’re in pain, and you can’t prove otherwise. There’s no way to stop them from getting their medication.”