Roger West


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Strategies to Prevent "Pill Mill" Diversion
National Rx Drug Abuse Summit 4-10-12

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Roger West

  1. 1. Total Statewide (KY) Overdose cases by year 2004-2009 Source: FBI Intelligence assessment 15 August 2010
  2. 2. Statistics  In 2009 more people died in Kentucky from drug overdoses than vehicle collisions.
  3. 3. The Problem
  4. 4. The evolution of the Appalachian pill epidemic  KASPER came on-line in 2000  Investigators began conducting “Doctor shopping” investigations with the aid of KASPER.  KASPER solves Kentucky’s problem… for a while.  After continued prosecution “patients” began having to travel out of state to circumvent KASPER.
  5. 5. Kentucky Drug Trafficking Organizations  DTO leaders have educated themselves on which states have a prescription monitoring system and the rules regarding its use.
  6. 6. The scam of Kentucky DTO Sponsors  The leader of the DTO recruits others to travel to the physicians or clinics.  The leader provides funding for the office visit, the filling of the prescription, their lodging, food, gas and any other expenses incurred.  The leader of the DTO and the “patient” split the prescription 50/50.
  7. 7. The Timothy W. Hall DTO and Urgent Care Services  One of the earliest known DTO’s traveling out of state in this organized manner was the Timothy Wayne Hall DTO  Hall’s organization traveled to Urgent Care Services of South Philadelphia and obtained large amounts of Methadone 40 mg tablets and distributed them in Eastern Kentucky.
  8. 8. September 2005  Received information from the Floyd County, KY Commonwealth’s Attorney’s office which indicated several KY residents had prescriptions for narcotics filled at a local Philadelphia pharmacy.  DEA Diversion had executed an administrative inspection warrant in July 2005 for records at Pharmacy Express in Philadelphia.  The warrant revealed over 140 Kentucky residents were traveling to Philadelphia, PA in order to receive large amounts of Methadone 40mg tablets from URGENT CARES SERVICES located in PA.  Hall’s organization was identified as traveling to UCS.
  9. 9. Methadose 40 mg tablets
  10. 10. Timothy Wayne Hall DTO  Among those receiving scripts at UCS in Philadelphia was members of Hall’s DTO. We were able to identify, target and convict 17 members of Hall’s organization in US District Court in Pikeville, KY.  Hall also had Detroit, Michigan sources of supply for Oxycontin tablets. We indicted two of those subjects, one has pled and was sentenced, one remains one the run.  Hall’s group included Larry Goble and Damon Newsome.  Newsome was a recently retired Deputy Jailer for Floyd County and also ran for Floyd County Sheriff in the May 2006 primary.  Newsome’s campaign was financed by Hall.  Goble was a former Floyd County Deputy Sheriff.
  11. 11. Hall’s profit potential
  12. 12. Urgent Care Services  Nationwide chain of clinics.  Based in Slidell, Louisiana; with clinics in Philadelphia, Cincinnati, Tulsa, Little Rock and elsewhere.  Timothy W. Hall organization linked to this clinic.
  13. 13. URGENT CARE SERVICES  Based in Slidell, Louisiana
  14. 14. Investigative Strategyconcerning Urgent Care Services
  15. 15. August 23, 2007  FBI Agents from Kentucky and Kentucky State Police Detectives deputized under an OCDETF agreement executed a search warrant on UCS in Philadelphia, with assistance from FBI and DEA in PA.  During search warrant, Dr. Randy Weiss admits to prescribing Methadone tablets to KY residents without a legitimate purpose.  Weiss stated he was pressured to do so by UCS corporate officers, Tonia Snook, Steven Lyon and Michael Leman.  UCS in Philadelphia was shut down.
  16. 16. Results  Over 30 individuals have been convicted, including two physicians and one pharmacist. All have pled guilty.  D.O. Randy Weiss from the Philadelphia clinic was sentenced to 48 months in prison.  D.O. Stan Naramore from the Cincinnati, Ohio clinic was also sentenced to 48 months in prison.
  17. 17. D.O. Randy Weiss
  18. 18. D.O. Stan Naramore
  19. 19. D.O. Stan Naramore
  20. 20. Dr. Stan Naramore “A Questionable Doctor”  1994 - Charged in Cheyenne Co. Kansas state court with one count attempted murder and one count of murder, resulting from questionable practices in 1992 concerning two of his patients.  1996 – Convicted on both counts.  1997 – Released on Parole  1998 – Kansas State Court of Appeals overturned conviction, acquitted Naramore, and forbid the Attorney Generals office from retrying him.  Out of work until “given a second chance”.  Hired by UCS in 2006.
  21. 21. Results
  22. 22. Urgent Care ServicesStephen Lyon Tonia Snook
  23. 23. Results  In April 2010 Michael Leman, owner of UCS was arrested and charged with Conspiracy to Distribute Oxycodone / Methadone and Conspiracy to Commit Money Laundering in the Eastern District of Kentucky.  March 5, 2012 Leman went to trial in Lexington, KY on these charges and on March 27, 2012 after two hours and five minutes of deliberation, the jury found Leman guilty on both counts.  We also received an $825,000.00 money judgment for proceeds received from Leman and the two corporations.
  24. 24. Urgent Care Services Michael Leman
  25. 25. Stark Pharmacy  Thomas Stark, a registered pharmacist in Cincinnati, Ohio, conspired with Naramore during this time to fill all of Naramore’s scripts.  Stark filled prescriptions Methadone 40 mg tablets totaling approximately 300 tablets in 2006.  Stark’s Methadone numbers skyrocket to 99,000 for 2007. (Led the state of Ohio)
  26. 26. Stark also charged  Stark was charged in our UCS Conspiracy, has pled guilty and received a 24 month sentence.
  27. 27. Then comes South Florida
  28. 28. Trend shifts and Kentucky folks move to warmer climates
  29. 29.   They actively recruited Kentucky patients because they were willing to pay in cash every month and keep coming back.  They rarely accepted insurance, only accepted cash.  Urgent Care Services went so far as to provide their medical staff with discount coupons that could be redeemed for free visits if patients referred other patients to their clinics.  Urgent Care Philadephia’s receipts indicated approximately $500,000.00 was taken in as revenue from Kentucky patients.  Urgent Care Cincinnati receipts are estimated to be over $1,000,000.00 from Kentucky patients.
  30. 30. Strategy
  31. 31. Kentucky’s response to pill surge from Florida
  32. 32. Clinics  Florida Global Medical  Lauderhill Medical Clinic  American Pain
  33. 33. WSVN channel 7 in Ft.Lauderdale, Florida news clip 11/10/2008
  34. 34. KSP photos of Americas Pharmacy
  35. 35.   Identify and build an investigation in and around the DTOs that are known to travel to South Florida to obtain medication for resale in Kentucky.  After addressing the DTOs, we began to focus on the source of the drugs, “The Doctors”, and build the proof necessary to prove the case.  Next build evidence against the corporate officers or owners of the clinics themselves.
  36. 36. Focus on DTO’s  Identify and build an investigation in and around DTO’s that are known to travel to South Florida to obtain medication for resale in Kentucky.
  37. 37. Marsillett DTO
  38. 38. Marsillett DTO  Taking two vans and RV load of people to a South Florida Pain Clinic.  Pays for all expenses and then splits pills with people he sponsors.  KSP has interdicted several of his DTO members and currently have approx. 2000 tablets in hand.  Members of DTO were stopped in Florida in February 2009.  All DTO members have pled guilty and been sentenced.
  39. 39. Identify the Physicians and clinics being utilized  After successfully building the investigation with the DTO’s, begin focus on the source of the medications, “The Doctors”, a build proof necessary to prove the case.
  40. 40. Lauderhill Medical Clinic  On April 29, 2010 a federal search warrant was executed on the clinic, seized were 1,700 patient files. (approximately 90% were Kentucky residents).  On May 24, 2010, we arrested Dr. Michael Shook on a federal criminal complaint from the Eastern district of Kentucky.  Clinic owner Gary Adams is alleged to have structured over two million dollars in cash deposits to four banks between May 2008 and January 2010.
  41. 41. Lauderhill Medical Clinic – Oakland Park, Florida
  42. 42. Dr. Michael ShookShook stated he made over $300,000 for year 2009
  43. 43. Michael Shook M.D.  May 2011 Michael Shook was sentenced to 48 months in prison.
  44. 44. Stand by more to come  We have several cases ready to indict concerning pill mill investigations using these same type investigative stratiegies.
  45. 45. Ouestions??? AUSA Roger West Lexington, KY