Safety and OSHA News

Pill mill docs who got millions in kickbacks for prescribing opioids sent to prison

To combat the opioid addiction crisis in the U.S., investigators and prosecutors are ferreting out doctors who over prescribe the pain meds. Example: Two Alabama doctors are now going to prison for a very long time. 

Dr. John Patrick Couch and Dr. Xiulu Ruan were sentenced to 20 years and 21 years respectively in federal prison for running a massive pill mill in Mobile, AL.

Prosecutors say Couch and Ruan received kickbacks in exchange for prescribing huge amounts of Subsys, an instant-release form of fentanyl, from Insys Therapeutics, the drug’s manufacturer. Couch and Ruan were among the top prescribers of Subsys in the U.S.

But that wasn’t enough money, apparently, for the two doctors. Evidence showed they purchased $1.6 million worth of stock in Galena Biopharma, the manufacturer of Abstral, another instant-release form of fentanyl. Then, Couch and Ruan sought to manipulate the stock price by driving up Abstral sales. For an 18-month period, Ruan and Couch were the No. 1 and No. 2 prescribers of Abstral in the U.S. Nearly one out of three Abstral scripts were written by the two doctors.

Both Subsys and Abstral are FDA-indicated only for breakthrough cancer pain. Couch and Ruan prescribed the drugs off-label for neck, back and joint pain.

The two doctors also profited from a workers’ compensation dispensary they owned. Couch and Ruan received monthly kickbacks of up to $100,000 from a dispensary management company in exchange for dispensing certain drugs with high reimbursement rates. These kickbacks reached into the millions.

How rich did the two doctors get? Couch and Ruan have agreed to forfeit to the U.S. several houses, beach condos and 23 luxury cars, including multiple Bentleys, Lamborghinis, Mercedes and Ferraris. They’ve been ordered to pay almost $14 million in restitution to Medicare, Blue Cross/Blue Shield of Alabama, Tricare and United Health Group.

After a seven-week trial, 81 witnesses and three days of deliberation, a federal jury convicted Couch and Ruan of a laundry list of charges, including conspiracy to:

  • Prescribe Schedule II and III Controlled Substances outside the usual course of professional practice
  • Prescribe more than 40 grams of fentanyl outside the usual course of professional practice
  • Commit healthcare fraud
  • Receive illegal kickback from two dispensary management companies related to their workers’ comp dispensary
  • Receive illegal kickbacks from Insys in exchange for prescribing Subsys.

Both doctors were also convicted of several substantive illegal drug distribution counts related to prescriptions written to particular patients.

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