The Criminal Division Discusses Combating the Opioid Crisis

ACTING ASSISTANT ATTORNEY GENERAL FOR THE CRIMINAL DIVISION BRIAN RABBITT: You know this initiative isn’t just about arresting bad guys. It just isn’t about putting numbers on the board or protecting the Treasury and Medicare and Medicaid, it’s about helping people. It’s about protecting individuals in the communities that we’re targeting and it’s about saving lives ultimately.

HOST: From the Department of Justice in Washington D.C., this is the Justice Beat.

Welcome to The Justice Beat where we sit down with top leadership to chat about the department’s mission, activities, and priorities. Today, we welcome the Criminal Division or, as we saw here, ‘Crim’.

They develop, enforce, and supervise the application of federal criminal law and prosecute a broad array of cases. To give you just a taste of the scope of cases they handle, offices in the Criminal Division cover topics from money laundering, narcotics, child exploitation, computer crimes, human rights, and much more.

In today’s episode, we discuss how DOJ is combatting the opioid crisis. 

Opioids are a class of drug that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers that are legally available by prescription, such as oxycodone, hydrocodone, codeine, morphine, and many others[i][i].

According to the CDC, from 1999 to 2018, almost 450,000 people died from an overdose involving opioids, including prescription and illicit opioids.[ii]

Brian Rabbitt, the Acting Assistant Attorney General for ‘Crim’ discusses how his division focuses their efforts on this crisis, why time is of the essence in these cases, and what the Department is doing to combat this epidemic.

Principal Deputy Director for Public Affairs Matt Lloyd, leads the conversation. here’s Matt.

MATT LLOYD:  Hello, this is Matt Lloyd. I’m the Principal Deputy Director of Public Affairs at the Department of Justice. I also serve as spokesperson for the Criminal Division. I am here today to interview Brian Rabbitt, who is the Acting Assistant Attorney General of the Department’s Criminal Division. Welcome Brian.

RABBITT: Thanks for having me here today, Matt.

LLOYD: Can you tell us a little about your background, maybe your path that got you to the Justice Department, if you will?

RABBITT: Sure, you know Matt I grew up in Virginia, in the northern Virginia area and I’ve lived in the Washington, D.C. area most of my life. I came back here after school, after Law school in Virginia, and clerking and went to work at a Law firm here in town. I was there for close to 7 years. In 2017, after the President won, I joined the White House Counsel’s Office where I worked for roughly a year, before I moved over to the SEC where I worked for the co-directors of enforcement initially focusing on financial fraud and the SEC’s enforcement program. After a little while I moved upstairs to work the chairman of the SEC, Jay Clayton, who I had become close to and I advised him on a whole host of matters including enforcement and financial fraud matters. In late 2018 when Attorney General Barr- now Attorney General Barr was nominated I moved over from the SEC to the Justice Department and worked with him on his confirmation. When he was confirmed in February of 2018, I stayed on as his Chief of Staff for the better part of the year before moving down here to the Criminal Division in March of this year.

LLOYD:  Can you give us a little bit of a background on how your current job as Acting Assistant Attorney General of the criminal is different from the Chief of Staff Job?

RABBITT: Absolutely. The Chief of Staff Job is incredibly interesting, it’s a… you have a very broad lens when you’re working for the Attorney General in that office in that position. But at the same time while you’re aperture is a mile wide it’s only an inch deep. You really only have time to focus quickly on a number of issue. There are all sorts of interesting issues that come to you every day, but you really only have time to pick them up for a minute make a decision and then move on to the next thing. One of the reasons that I was so interesting in moving down to the Criminal Division this year, because I am a lawyer by training, I’m a litigator and I missed the ability to kind of get my hands on cases. To take a little bit of a deeper dive on specific issues. So in the Criminal Division obviously being the Acting Assistant Attorney General you still have a very broad lens, the Criminal Division does a lot of different things and I have a lot of responsibility in terms of overseeing those but I do have more time to do a deeper dive on each individual issue. I have the opportunity to get closer to individual cases and work more closely with the line prosecutors which is again is where my background was. So I think it’s really the difference of between having a very wide lens and only limited ability to kind of get directly involved in issues versus having a little more time to get closer to issues and cases in the Criminal Division.

LLOYD: Let’s dig deep into some of the things that you’re working on in the Criminal Division. We’ll start with opioids and drugs. In 2019, approximately 72,000 Americans lost their lives to drug overdoses.  Behind every loss to addiction are families and friends who mourn, and communities that suffer. Combating the opioid epidemic is a significant priority for the Trump Administration, and DOJ, and the American people.  I know the Criminal Division has focused on this and targeting the key contributors to this ongoing crisis – specifically the doctors and medical professionals. Could you give us a little bit of background and maybe some of the specifics of what you’re doing to target and help our efforts in combatting this epidemic?     

RABBITT:  The Criminal Division’s Fraud Section has been focused on healthcare for a long time it’s kind of squarely within our mandate of protecting the public fisc against fraud. As you know many patients rely on Medicare and Medicaid which are in turn paid for by the federal government. Or in the case of Medicaid by the federal government and the states working together so that’s kind of squarely what we do within the Criminal Division within the Fraud Section. You know as part of that we noticed that the last number of years that opioids were kind of a growing problem so we made a decision to shift our focus to concentrate a little bit more on combatting the opioid epidemic in particular as it relates to certain areas of the country. The Appalachian area where there has been significant uptick in opioid abuse and deaths are resulting from that. And one thing that we noticed from our work is that those that are dying from opioid overdoses primarily get them from two sources. The first is on the street from drug dealers and the second is through prescriptions from doctors. You know the only way an addict or somebody who’s dependent on opioids is going to get a prescription is for a doctor or a medical professional to provide it to sign for it.

The overwhelming majority of doctors in America, I think we know and have found are honest professionals who are committed to the responsible treatment of their patient and the responsible use of opioid-based medications for legitimate reasons. But, as in everything else there are bad actors out there and in the medical profession those bad actors, those individuals who are willing to abuse opioids can really have a significant impact by providing addicts with access to something that can be very dangerous.

So based on more than 10 years of health care fraud casework, we know that doctors are highly deterred through criminal prosecution – meaning that if we put a doctor in prison for illegal conduct, his or her colleagues do take notice. They do sit up and pay attention when one of their colleagues goes to jail. They realize if they start acting like drug dealers, like criminals, the Justice Department is going to treat them like criminals and like drug dealers. They realize that the financial incentive for over prescribing opioids or issuing illegitimate prescriptions for opioids just isn’t worth the risk of going to prison over it. So we found we can have a tremendous effect by going after bad dishonest doctors. They are really a lynch pin in the system. We’ve also found that opioid over prescription and healthcare fraud are problems that we often see together, in the same case. Every time a prescriber issues a prescription that a patient doesn’t need there is a corresponding drain, Matt, on the healthcare system. In some cases patients pay for doctors’ visits out of their own pockets but in many cases, as I was referring to earlier, they are covered by private insurance or Medicare or Medicaid and those coverage systems typically pay. And in the case of Medicare and Medicaid it’s really ultimately the tax payers and the state and local level that pay. They also pay for the resulting illegitimate prescriptions.

 Sometimes, we found that once a bad doctor has “hooked” a patient on opioids, they will further inflate the bill by charging not only for the office visit but to prescribe the opioids but also for medically unnecessary tests or services that are in fact never provided.  These are all fraudulent practices that harm not only patients, in the case of opioid dependence, but also the healthcare system and the federal fisc.

Another common fact pattern that we noticed that has encouraged us to get involved in this space is something known as “patient recruiting.” We’ve found that in a number of cases patient recruiters will solicit Medicare beneficiaries – sometimes in return for cash, sometimes in return for other benefits – to patronize specific clinics that providers have to obtain prescriptions for opioids in their name, again, covered by insurance or government healthcare programs.  The recruiters may even go so far as to pick up patients at their homes and take them to one or a series of what we call “pill mill” clinics and they instruct them in terms of what to request from a doctor, how to describe their symptoms, how to get unnecessary or illegitimate prescriptions from a corrupt doctor. Now instead of taking those medications and using them for their own benefit, we found that the patients, in effect, sell their controlled substance prescriptions to their recruiters, who often fill them and then divert the prescribed medications for further sale on the street. And the corrupt doctors that are involved in this scheme, for their part, receive cash in terms of kickbacks from the recruiters, or in-kind benefits in terms of being able to use these recruited patients’ insurance information, as I mentioned earlier, to bill for unnecessary or unprovided tests or services. So you really have a group of folks working together in concert exploiting individuals who are addicted to opioids to pray on not only them but on the healthcare system, on private insurance, on Medicare and Medicaid, as well. So we’ve identified these kind of interrelated problems over the last several years, they all dovetail very closely with the work we’ve traditionally done in the healthcare fraud space. And it’s something that we tried to sit down and allocate our resources and decide what we’re going to focus on we decided that this is somewhere we could have a positive benefit. We could really make a difference for both those who are suffering from opioid addiction, but also for the Treasury as well. 

LLOYD:  Let’s talk a little bit about the doctors. We all know that there’s millions of doctors in America most of them are fine upstanding citizens, in it for the right reasons. How do you determine which doctors to target when you’re addressing this problem? 

RABBITT: I think you’re absolutely right. There are millions of doctors, in America, who have millions of patients who as I said use opioids for appropriate reasons, medically necessary reasons.  I happen to be the son of a doctor, and I know that the vast majority of doctors in America are honest professionals who are just trying to treat their patients in a responsible way.  

But there are certainly bad actors out there, there’s no question about that. And to find them, we use primarily data, anrd data analysis. For years the division has been using and analyzing data to find individuals who are defrauding Medicare and other federal healthcare programs through various schemes that I was talking about before.  We’ve developed substantial expertise in data collection and data analysis.  We are continuously refining our methods to kind of comb through the data that is available to us to find outliers. And taking a look at a vast data set and kind of identifying where the outliers are and then focusing investigative resources on them and building cases based on those leads. We don’t bring cases based solely on data analysis.  We always combine data analysis with more traditional investigative techniques. But data analysis does allow us to quickly develop those leads to narrow our searches to find that proverbial needle in a hay stack, so we can then use our traditional law enforcement techniques and methods to determine whether we’re seeing is just a unique but lawful practice or in fact something that is unlawful, something that is fraudulent that we need to focus on and potentially take action. So that’s something that we’ve used for years in the healthcare fraud space more generally and when we decided to put more of a focus on the opioid crisis and how we can make inroads there, we took that expertise and we adapted our model for use in the opioid crisis. We get data from a wide variety of sources and we’ve created parameters that help – and continue to help – us to find the dirty doctors. For example, doctors that are prescribing opioids at extremely high levels. Those who are claiming to see more opioid patients in a single day than a normal doctor would see in a week or a month. We can get that data, we can sort that data we can identify those outliers and then follow up with some of the more traditional techniques that I was talking about earlier. So the data analysis essentially gives us a list of potential leads and targets and then we work with our investigative partners at the FBI, HHS-OIG, DEA, and other federal agencies to determine if what we’re seeing, like I said, is reflective of legitimate healthcare activity or instead illegal activity. Then we work the cases, we build the evidence, and if they point to criminal activity, if we believe we can prove it, we will bring cases and charge those individuals.

LLOYD:  I know you have got a large health care fraud unit, but the battle is large and how do you determine how to focus your efforts, where to focus your efforts, and what help are you getting from other parts of the department?

RABBITT: In the first instance we let data dictate where we were going to focus our enforcement efforts. When we first began this initiative, we looked at the data that was available to us and we were pretty quickly able to identify what I would call hot spots for opioid abuse, opioid overdose fatalities. And we made the decision to surge resources in those areas to try to bring help to them as quickly and effectively as we possibly could. Those areas were Alabama, Kentucky, Ohio, Tennessee, West Virginia, Virginia and associated regions. We used data to identify the communities within those areas that were suffering the most from the opioid crisis and we surged our resources there to bring those folks relief.  Based on our analysis, we created what we’ve called the Appalachian Regional Prescription Opioid – or ARPO – Strike Force and we deployed prosecutors with experience prosecuting doctors in other types of health care fraud to these overdose hot spots to build cases against doctors and other enablers who are prescribing illegal opioids to those who are dependent on them. But it also important to note that we can’t be successful and we haven’t been successful without the support and the partnership of prosecutors in the U.S. Attorneys’ offices in these hotspots. In particular, the Middle District of Tennessee and the Eastern District of Kentucky have been particularly strong partners and they really serve and have served as hubs for the work that we’re doing in these regions. These offices have great leadership and fantastic prosecutors, with a significant amount of experience in the healthcare fraud space and they have devoted significant time and resources to support the Criminal Division and the Department’s efforts to tackle the opioid crisis. They know how the courts operate in their part of the country. They know how to get things done there. And most importantly, they are closest to and really most familiar with the communities – often very rural communities – that we are trying to help through this important initiative.  So essentially it’s been kind of a one two punch combining our laser focus and expertise on healthcare fraud with the on the ground expertise and the resources of these regional U.S. Attorneys’ offices and that’s really allowed us to move quickly and very effectively with our partners to bring as much help as we possibly can, as quickly as we possibly can to these communities that are suffering the most from the opioid epidemic.

LLOYD:  That’s tremendous work. Let me dive in a little bit to the speed at which you go. I know sometimes, sometimes it takes a while to bring a case. Why is speed important when we’re talking about addressing this problem?

RABBITT: We are targeting in this effort, doctors and other enablers who are illicitly prescribing very high levels of opioids to addicts and otherwise vulnerable people in some of the poorest areas of the country.  These supposed medical professionals are using their positions of trust to exploit a very vulnerable patient base, in most cases a patient base that is often very disadvantaged. These patients need our help, and frankly they need it yesterday.  By acting quickly, we are able to take bad actors and bad doctors’ ability to write abusive prescriptions away as quickly as possible. And in doing so, we also deter other medical professionals from getting into this sordid business in the first place.  So really the speed helps us or enables us to get relief to these communities quickly and it also enables us to hopefully cut off this conduct in other individuals before it even occurs. Quick prosecutions Matt, I think we found, mean a quick reduction in supply. And that can translate to lives saved, and that’s really at the heart of what we’re trying to do here.

A number of our cases Matt, I think really show how quickly we are moving here. For example on August 10^th of this year, so again in the middle of the COVID-19 pandemic.   A jury in the Southern District of West Virginia convicted Dr. Ricky Houdersheldt on 17 counts of unlawfully dispensing opioids. Those charges stemmed from the doctor’s role in prescribing opioids that had essentially no legitimate medical purpose and were outside the usual course of professional practice, including we alleged at trail and proved at trial, exchanging prescriptions for cash and requests for sexual favors and female companionship from patients, so really, truly reprehensible conduct. The matter is pending sentencing, but we charged the case in September of 2019, so we were able to charge that case and bring it to a verdict in the community, in less than a year- during the COVID-19 pandemic. Which I really think speaks to the speed in which we are trying to move here and the resources we devoted to these cases.

So, Matt, just to kind of sum it all up, in these cases we are targeting those doctors and medical professionals who are poisoning their communities. All of whom have professions and livelihoods on the line, and will often put up a rigorous defense and go to trial. Drug and fraud crimes are serious offenses, they can carry potentially long prison sentences. So as with every federal prosecution it’s essential and necessary that our evidence prove criminal conduct beyond a reasonable doubt.

But with patient lives at stake, and with communities that are suffering so much from the opioid epidemic, we really can’t afford to investigate indefinitely, digging for every last bit of evidence of a potential crime that these defendants may have committed. What our model, that we put together, allows us to do is to quickly identify, investigate and charge, serious misconduct and to quickly move cases from investigation to indictment to conviction. The average time from case initiation in this initiative to indictment has been 6 months. It usually takes much longer, but in this instance we’ve recognized the importance of we surged resources and we’ve tried to move as quickly as we can while still being mindful of the need to investigate these cases and prove them at trial.

LLOYD: Anybody who has been somewhat involved at least tangentially in law enforcement will know that criminals really don’t take a day off and it seems like once you address one problem another one pops up.  How would you define success here? How will you know that you’ve made a difference, now that you’ve been at this for more than a year?

RABBITT: It never ceases to amaze me how creative criminals can be and how smart they can be. I almost call it criminal arbitrage: when you push back in one area, criminal activity pops up somewhere else. They are very adept in finding seams in the system and exploiting those for their own criminal purposes. One often wonders whether these folks if they were to dedicate their ingenuity and their smarts to actual legitimate activity how successful and smart they could be.  I think we’ve been indisputably been successful and I think we’re absolutely making a difference here. In total, through the ARPO initiative that I mentioned earlier, we’ve brought cases charging 73 defendants, of which 53 were opioid prescribers and pharmacists, who prescribed or dispensed approximately 50 million prescription opioid pills, 41 of these defendants were doctors. To date, 30 of the ARPO defendants have pleaded guilty and two additional defendants have been convicted at trial.  In terms of the time that we’ve been working on this ARPO initiative, those are really significant results. Those are real meaningful numbers that reflect a significant amount of work by the Department of Justice, by the Criminal Division and our U.S. Attorneys’ offices partners. We’ve really made a commitment to this initiative and I think it’s indisputable that its showing results.

So Matt, in addition to those numbers I think we’re going to continue to look at the data. To see how successful we’ve been, you know data analysis has been very helpful in terms of helping us build these cases. I think data analysis is something that we have returned to and will continue to return to over time to assess how we’re doing and where we need to change or refocus our efforts. So I think we’re going to follow numbers in this case. If they tell us that we need to add communities, then we will. If they tell us that we are making a difference in communities such that we can refocus our resources – we’ll do that too. But I think the data that I mentioned a few moments ago, and the data that we’re seeing right now absolutely shows that we’re making a difference. But it also shows that we have a lot more work to do and that’s why we’re committed to this for the long haul.

LLOYD:  That’s great. It’s incredibly promising as well. You can’t really talk about opioids without talking about the issue of treatment, as well. So, I wanted to turn to that next. Many of those who are addicted will turn to another dirty doctor or find heroine being sold on the street or what have you. How do you address the challenge, the treatment challenge, to make sure you’re making a difference in the lives of those who are abusing the drug in the first place?

RABBITT: It’s a really difficult issue, Matt. When we were bringing our first takedown a large number of cases in April 2019. We thought long and hard about the treatment question. As I mentioned earlier, this initiative isn’t just about arresting bad guys. It isn’t just about putting numbers on the board, protecting the treasury, Medicare and Medicaid. It’s about helping people. It’s about protecting individuals in the communities that we’re targeting. And it’s about saving lives ultimately. Obviously treatment isn’t our area of expertise. We’re the Department of Justice, we go after bad guys. But this is absolutely something that we have to think about and it’s something that we do think about. We knew when we got into this that with more than 50 doctors and other medical professionals being arrested in that first take down that I mentioned ,all in one day, all in one morning throughout different regions in Appalachia, we were going to see patients showing up at doctors’ offices across numerous communities and a number of different states all in need of help. Folks that were addicted to opioids who couldn’t just cut themselves off cold turkey, that really needed help and treatment. We wanted to be part of the solution to provide them that help. So, what we did we partnered with state and federal health professionals to ensure that treatment was made available to anybody who needed it, who was a patient of the individuals who we were taking down, who we were arresting. We worked together with partners of ours at the Centers for Disease Control and other local agencies at the state level and local level to ensure that those effected patients could have continued access to care, to treatment, to counseling. And at the same time were redirected from the more abusive doctors that we were targeting with our operations to legitimate medical professionals in their communities who could provide them with actual counseling, with actual treatment, and with actual help to make a positive impact on their addiction as opposed to just exploiting them for criminal purposes. So, we have to absolutely think about this question anytime we take down a doctor who’s exploiting and abusing a large patient community.

LLOYD:  So what’s next? How long do you expect to be using this model?

RABBITT: When we first got into this we made commitments to these communities that we surged resources to that we were operating in that we would be in this for the long haul. This isn’t just something where we would come, we would arrest a bunch of bad guys, get a bunch of headlines and move on. That’s not what we are trying to do here. We plan to stay in these communities until the data, the data that I mentioned earlier, tells us that it’s ok to move on. That we’ve really made a concrete improvement in the communities in terms of folks dependence on opioids. We believe we’re well on our way to achieving that goal. I think the data is pointing in a better direction. I think the numbers show us that we are actually making a concrete difference. We are stopping corrupt medical professionals in their tracks. We are providing services or arranging to have services provided, to those in need. And we’re really working to prevent the next tragic loss of an individual in these communities to the opioid epidemic. These cases have become very important to the Department of Justice, to the Criminal Division. It’s something that we can point to and know that we are really making a difference in people’s lives. If we can save one more life in connection with this law enforcement operation I think that will really have made the effort worth it. So, we’re certainly committed to this.

LLOYD: What other sections, other than fraud and the Criminal Division, are involved in this fight?

RABBITT: With the opioid epidemic, we’ve got a number of different sections involved. One section in particular is the Narcotics and Dangerous Drugs Section in the Criminal Division, or NDDS. They’re directly involved in our work in this area particularly as it relates to combating the smuggling of deadly illegal fentanyl and fentanyl analogues from Mexico and China. In addition to NDDS, and in addition to Fraud we also have several other sections of the Criminal Division involved as well. It truly is an all hands effort.  For example, we have an Organized Crime and Gang Section, OCGS. I think they’ve had a really meaningful impact as well. In addition, to the Fraud Section and in addition to NDDS’s work.

LLOYD:  I wanted to dive in a little bit you’ve mentioned organized crime. The organized crime and gang section when most people hear of organized crime, they think oh the mafia. What exactly has OCGS Organized Crime and Gang Section been doing to combat the opioid crisis?

RABBITT: That’s exactly right. One of OCGS’s traditional focuses has in fact been organized crime. That can mean many things. That can mean the mafia, as you pointed out. It can also mean transnational criminal organizations and cartels that operate in the United States and globally. You know the Section’s mission, though, is much broader than just focusing on what we would traditionally think about here as organized crime. Generally speaking OCGS prosecutes organized crime groups that operate internationally, nationally, and regionally – that is, in multiple jurisdictions around the country and around the world.  The OCGS mission includes the targeting of organized criminal groups that engage in illegal activity including narcotics trafficking, and specifically including the illegal and fraudulent prescription and trafficking of opioids. One thing that really helps OCGS in this area, that helps them kind of tackle these organizations that are involved in illicit drug trafficking, a particularly potent weapon is the Racketeering Influenced and Corrupt Organizations – or RICO – statute.  RICO is frequently deployed by the Department against organized criminal groups. Going back to the mafia that you mentioned earlier you may have heard about it in connection with the great work the Department historically did to dismantle organized crime in that area.  But it is actually a much broader statute than that, it’s not limited to that context and it is something that OCGS can – and does – bring to bear in the Department’s fight on a number of different fronts including the opioid epidemic.

 LLOYD:  So anybody who has watched a cop show has probably heard the term RICO. Can you give us a little bit of an idea for us non-lawyers and non-prosecutors, maybe a little bit about what that means. 

RABBITT: I am going to simplify a great deal here, so any lawyers listening to this podcast may cringe a little bit, but for our lay audience: RICO is a statute that essentially allows us to target criminal organizations more effectively. It allows us to bring charges against the leadership and members of criminal organizations for taking steps to advance the work and advance the goals of the organization or for directing others to do so. So it’s really a tool that allows us to take disparate crimes that are committed on behalf of, or in support of, or in furtherance of an organized enterprise and to prosecute that kind of a holistically and really target and go after the leaders and the supervisors within that criminal organization.

LLOYD:  That’s great, so how have you been able to use RICO to address and tackle the opioid crisis?

RABBITT: For one thing Matt, I think that we found RICO is a particularly effective tool or has the potential to be an effective tool, in opioid trafficking cases and pill mill cases. RICO allows prosecutors to include, in one indictment, in one case, a wide range of types of defendants regardless of their significance in the organization or their role. The statute also allows prosecutors to include -- again in one indictment, in one case -- a variety of different charges including narcotics trafficking charges, maintaining drug premises charges, money laundering charges, fraud charges. A lot of these crimes often go together, so you’ll have a combination of illegal dispensation of drugs combined with more traditional healthcare fraud like patient recruitment efforts, kickbacks, billing fraud and that sort of thing. One of the things RICO does, is really allow us to bundle those charges up into one case and bring it together in a much more efficient vehicle. And finally Matt, the statute is particularly useful and helpful in allowing us to target organizations that operate across multiple federal jurisdictions. So if there’s an organization that is operating regionally or nationally and a defendant is kind of taking actions in various spots around the country, we don’t have to charge them in multiple places, we can bring one case, in one jurisdiction.

LLOYD:  What about OCGS and the work that they’ve done in this space? Can you speak to that maybe a little bit?

RABBITT: Sure, I can give you an example and this is something that’s relatively new for OCGS and we’re looking to try to expand on and deploy this tool further as we move forward. OCGS wrapped up a 3 month trial in a significant RICO pill mill case in the Eastern District of Tennessee and the case really arose out of the operation of pain management clinics by the Urgent Care and Surgery Center, or UCSC, that was originally located in South Florida and had some branches in East Tennessee. What these clinics were, to put it bluntly, were pill mills where medical providers wrote unreasonable and medically unnecessary prescriptions for opioids and other narcotics for patients who were addicted. In early 2009--this case dates back quite a while--three co-owners, two of them were Italian defendants, Luca Sartini and Luigi Palma and a third Benjamin Rodriguez, opened a UCSC pill mill clinic in Hollywood, Florida. There was another woman, Sylvia Hofstetter, whom they hired to help them manage that clinic. Now Sartini, Palma and Rodriguez had, when they brought Hofstetter on board, already agreed to expand their operations to Tennessee. In 2010, they opened a number of UCSC pill mills in the Knoxville, Tennessee region. They then again turned to Hofstetter to manage the pill mill clinics and build client volume. We first began looking at this operation in 2013 when the FBI opened an investigation into the Tennessee UCSC pill mills. These pill mills were seen as the most egregious of dozens in the business that were fueling the opioid epidemic at the time. The FBI conducted a raid on all of the UCSC pill mills in March 2015. At that time, over 100 people were arrested and a number of pill mills in Tennessee were searched and ultimately closed by the Bureau. Our investigation found that the owners and operators, who I mentioned before, made over 21 million dollars from the Tennessee pill mills alone.  The providers of the Tennessee clinics prescribed over 11 million opioid pills in just 3 ½ years. You know Matt, the facts here are really tragic. OCGS indicted the most culpable participants in this scheme. The owners and operators that I was talking about earlier Sartini, Palma, Rodriguez and Hofstetter and we were able to use the RICO statute that I was talking about earlier to charge them with RICO conspiracy and a number of other offenses. Now one of the five defendants pleaded guilty to RICO conspiracy charges. And late last year, four defendants including Hofstetter were tried in the Eastern District of Tennessee. Hofstetter was convicted of RICO conspiracy and her co-defendants in that trial were convicted of other drug related crimes. They are all currently awaiting sentencing.  One thing that I think is important to add too, as to the defendants that haven’t been tried and convicted yet the allegations in our indictment that we ended up talking about here today are of course only allegations and need to be proven beyond a reasonable doubt, in a court of law.

LLOYD:  That’s a great deep dive into what the Criminal Division here at the Department of Justice is doing to combat the opioid crisis. I know that there’s many departments across the administration, as a whole, who are involved in this as well. This has been great. Brian, any parting thoughts, anything you want to leave with the folks that are listening today?

RABBITT: Matt, we’ll just pick up on one thing that you just mentioned which is that this has really been a joint effort within the Department of Justice. You know the Criminal Division has obviously been carrying the flag on this, with the ARPO strike force and that is something that we’re very committed to, but as I mentioned earlier, we couldn’t do this without the support of our U.S. Attorney’s office partners. As well as, our partners at other federal agencies. Including in particular, law enforcement agencies, I think I mentioned earlier HHS-OIG, FBI, DEA of course, and a number of other key partners, so really it’s been a whole of government approach.

And I think the reason Matt why you’ve seen so many folks go all in on this because this is criminal activity that  is really decimating a number of communities in a number of key areas throughout Middle American. It’s costing us lives, often young lives and it’s really destroying communities and it’s destroying families.  And so, it’s something that we’re committed to pursuing. It’s something that we’re committed to combatting and we really want to make a difference here. I think we have made a difference. We’ve brought a lot of resources to bare on this, we’re in this for the long haul. We’re making a difference, but our job is not done yet. We’re going to keep fighting this fight.

 LLOYD:  I’ve heard it often said that everybody knows somebody who is effected by this. Whether it’s a family member of friend, so I commend you and your team there and your prosecutors and everyone working on this tremendous job, thank you for joining us today, Brian.

RABBITT: Thanks, Matt, thanks, and I appreciate the opportunity to talk about the Division’s important work in this area. Thank you very much.

HOST: The misuse of and addiction to opioids—including prescription pain relievers, heroin, and synthetic opioids such as fentanyl—is a serious national crisis.

The Department of Justice has partnered with educators, treatment professionals, and non-profit organizations, to bring awareness and develop strategies and solutions to fight the opioid epidemic.

If you or someone you know suffers from opioid addiction, get help by visiting FindTreatment.gov or by calling the National Hotline at 1-800-662-HELP, that’s 1-800-662-4357. Both the website and hotline are run by the Substance Abuse and Mental Health Services Administration, an agency of the U.S. Department of Health and Human Services.

Thank you to Brian and Matt for sharing what DOJ and the Criminal Division are doing to combat the opioid crisis.

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The Justice Beat was produced by the Department of Justice - Office of Public Affairs. Find out more about the Justice Department at Justice.gov.

[i] https://www.drugabuse.gov/drug-topics/opioids

[ii] https://www.cdc.gov/drugoverdose/epidemic/index.html