Superior Drugs: The Doctor Never Spoke to the Customer

Internet prescription fraud in the Superior Drugs case turned online and telephone questionnaires into prescriptions for customers whom the prescribing doctors never examined, according to the Justice Department’s announcement of the criminal convictions. A website operator paid the doctors to issue prescriptions and paid the Miami pharmacy to fill and ship them. The customer supplied the answers, the doctor supplied the prescription, and the drugs went out.

What Are Some Examples of Prescription Fraud?

Issuing prescriptions solely from questionnaires and approving them without speaking to the customer were practices in the Superior Drugs criminal case. In its announcement, the Justice Department reported that the pharmacist and website operator had been convicted at trial.

The website operator ran PricebusterRX.com and PricebustersUSA.com, selling prescription drugs, most of them controlled substances. Most customers completed an online questionnaire or answered questions over the telephone. The operator then paid physicians to review those answers and issue prescriptions based solely on them.

According to the Justice Department’s announcement, the pharmacist operated Superior Drugs in Miami and filled orders for numerous people and businesses selling drugs over the Internet. The principal drug was phentermine, a controlled diet drug. The pharmacy supplied the last step: filling the prescriptions and shipping the medication to the websites’ customers. The same January 3, 2013 announcement alleged that another website operator hired the pharmacist to fill and ship prescription-drug orders. The seller was paying the doctor who decided whether the customer got the drug.

An Examination Report Without a Conversation

Even an examination report in the customer’s file did not establish contact with the prescribing doctor in this case. The Justice Department reported that some customers sent the website operator reports of physical examinations allegedly performed by other healthcare professionals. The doctors approving the prescriptions never communicated with those professionals or with the customers themselves.

The report traveled through the business. The conversation did not.

The Justice Department also reported that a Texas customer died of a phentermine overdose and that a bottle of phentermine tablets from Superior Drugs was found in her home. The doctor who wrote her prescription was in Puerto Rico. Patients were the ones taking the drugs, while the seller paid the people approving and shipping them.

The announcement also reported a guilty plea by a Georgia-licensed physician. It described how he issued invalid prescriptions for customers he had neither seen, spoken to nor examined. He began working for the website operator in 2008, replacing a doctor who had been investigated and later prosecuted for writing invalid prescriptions. The business changed its prescribing doctor while continuing to obtain prescriptions without patient contact.

Prescription Fraud Beyond Controlled Substances

The criminal convictions also covered prescription drugs that were not controlled substances at the time of the conduct. The Justice Department’s announcement described convictions for conspiring to distribute misbranded drugs across state lines, naming carisoprodol, sold as Soma, and tramadol, sold as Ultram.

The pharmacy distributed those medications without valid prescriptions, too. For an insider handling its orders, the prescriber’s relationship with the customer mattered across the prescription business, not just for its principal diet drug.

Why April 13, 2009 Matters

The indictment distinguished internet distribution before and after April 13, 2009, the boundary it used for the federal internet-prescribing amendments. It alleged questionnaire-based prescriptions for phentermine and phendimetrazine. The amendments generally required at least one in-person evaluation by the prescriber for Internet prescriptions of controlled drugs, with exceptions for telemedicine and for a qualifying practitioner covering the patient’s care.

The pharmacy’s Internet business crossed that boundary. The Justice Department reported that its operator began filling orders for Internet pharmacies as early as 2002 and faced distribution charges extending through May 2010.

What Subscription Telehealth Changed

In a later complaint against Cerebral, a whistleblower alleged that continuing Adderall prescriptions required frequent telehealth visits. The complaint described video visits but alleged pressure to rely on diagnostic quizzes patients completed beforehand. It also connected prescribing incentives to claims for prescriptions, subscription services and appointments paid by federal health insurance programs.

Where the Prescription Trail Leads

The evidence in a questionnaire-prescribing case connects the customer’s answers to the clinical decision, the pharmacy order and the money paid for each step. An employee handling intake may know whether the questionnaire was all the doctor received. A clinician may know whether anyone spoke with the patient or checked an outside examination report. Someone in pharmacy operations may know which website sent the order and paid for fulfillment.

The 2024 Rutgers University Law Review paper Plausible Cause: Connecting the FCA and AKS in the Context of Health Care Fraud draws attention to how a telemedicine business is organized. In discussing federal fraud alerts, it identifies arrangements where practitioners lack information needed to follow up with patients and businesses that furnish only one product or product type.

The questionnaire, the outside examination report and the prescription can all exist as documents. What connects them is the work the practitioner actually performed. We examine that connection with the insider who understands how information moved through the business.

Where similar prescribing feeds claims to Medicare or another government health program, our whistleblower experts assess how the clinical account connects to the payment sought. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

You Know What Reached the Doctor

If you saw questionnaires approved without patient contact, or handled the payments that kept those prescriptions moving, speak with our whistleblower experts about the prescribing operation. We build your strongest healthcare fraud whistleblower case around the clinical decisions and the money, match you with healthcare fraud whistleblower lawyers who know prescribing and pharmacy operations, and remain your partners throughout the case.