A pain management clinic in Eastern Kentucky staffed by one doctor and a physician's assistant saw 60-65 patients a day who came from several different states. The doctor was aware of the many red flags signaling that his clinic was a pill mill. His physician's assistant examined patients and provided prescriptions to patients even though no doctor supervised her patient examinations.
The Sixth Circuit Court of Appeals affirmed the doctor's and PA's convictions and affirmed a $10 million forfeiture order against them.
Doctors, physicians' assistants and nurse practitioners (mid-levels) must be careful to establish a legitimate doctor/patient relationship and the doctor must see every patient on every visit if controlled substances are being prescribed. The doctor also must sign the scripts after personally examining each patient.