Listen to Thomas Prevoznik and Gary Cantrell discuss their work:
A Tennessee nurse practitioner who called himself the “Rock Doc” was said to be trading powerful hydrocodone and oxycodone pills, as well as fentanyl patches, for sexual favors. Several pharmacists around Dayton, Ohio, were accused of running a “pill mill” that dispensed more than 1.75 million opioid pills in two years alone. A Kentucky doctor was thought to be prescribing opioids to Facebook friends.
These were licensed professionals, entrusted with attending to patients’ medical needs and frequently paid by the federal and state governments to do so. But as federal authorities announced in 2019, they turned out to be among the 73 health care providers accused by federal authorities of feeding an addiction that hobbled Appalachia, ground zero in America’s opioid crisis.
They represented a new front in the war on opioids, – and with their arrests came evidence that modern drug pushers sometimes worked in offices and wore lab coats.
Three federal employees are credited with developing and leading the novel approach that led to the apprehension of the health care professionals: Thomas Prevoznik, deputy assistant administrator at the Drug Enforcement Administration; Joseph Beemsterboer, senior deputy chief at the criminal fraud section of the Department of Justice; and Gary Cantrell, deputy inspector general for investigations at the Department of Health and Human Services.
The three men led a multistate, multiagency effort that linked DEA pharmacy distribution data with payment data for medical and prescription services from HHS and received critical support from the HHS Center for Program Integrity and state Medicaid agencies.
They worked with FBI agents who conducted undercover drug buys and posed as patients who had audio and videotaping encounters with prescribers. They got search warrants and conducted interviews with patients and staff at pain clinics that catered to drug seekers. They carefully selected DOJ prosecutors to bring the cases to court in the six states.
Then they went a step further. They made sure the Centers for Disease Control and Prevention and state health officials were on the scene when they shuttered doctors’ offices and clinics, ensuring that patients who legitimately needed medications could get care.
“We were able to supply resources and help to patients who were displaced,” Prevoznik said.
Collectively, the trio of leaders and the dozens of agents and attorneys who reported to them comprised the Appalachian Regional Prescription Opioid Strike Force or ARPO, operating in Alabama, Kentucky, Ohio, Tennessee, Virginia and West Virginia.
By September 2019, within a year of its formation and after two rounds of multistate arrests for drug diversion and health care fraud, the strike force had charged 73 defendants. The majority were doctors and nurse practitioners.
In the first round of arrests in April 2019, 60 people were charged with the illegal distribution of 23 million opioids and other controlled substances. In September 2019, 13 individuals were charged in connection with the improper distribution of 17 million pain pills. So far, there have been 24 guilty pleas or convictions. These cases represent the largest prescription opioid enforcement effort ever undertaken, the DOJ said.
“Cantrell led the strike force’s data analytics development and worked with an HHS team to identify prescription hotspots,” said Christian Schrank, assistant HHS inspector general for investigations.
Prevoznik packaged and correlated that data with DEA information showing where drug wholesalers were sending controlled substances, information that had never been shared externally. “When we put those data points together and used law enforcement techniques, we were able to bring forward facts to the prosecutors,” Schrank said.
Beemsterboer oversaw the prosecution. He helped hand-pick 14 prosecutors, flew them to Washington, and “gave an impassioned speech about the opioid epidemic and how these people were selected to be the tip of the spear to prosecute these cases,” said Robert Zink, chief of DOJ’s criminal fraud section.
The project has had a tangible impact.
“The number of opioid pills dispensed decreased 21% in four months following the takedown in the Appalachian region,” said Lamont Pugh, a special agent in charge of the HHS inspector general’s office in Chicago. Additionally, 26% of Medicare beneficiaries who received prescription opioids in the four months prior to the arrests stopped receiving prescription opioids, authorities said.
“The opioid epidemic is the deadliest drug crisis in American history. The tireless efforts of these prosecutors had real impact in these communities and saved lives,” Beemsterboer said.
“But the statistics tell only part of the story,” Cantrell said. “I’m proud of agents who worked in short time frames and thought outside the box and worked with public health agencies for the greater good,” he said. “As law enforcement organizations, we moved beyond counting convictions as measure of success and started measuring success also by how it impacts taxpayers and the patients that are served.”