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

4. Total Statewide (KY) Overdose cases by year 2004-2009
Source: FBI Intelligence assessment 15 August 2010

5. Statistics
 In 2009 more people died in Kentucky
from drug overdoses than vehicle
collisions.

7. The Problem

8. 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.

10. Kentucky Drug Trafficking
Organizations
 DTO leaders have educated
themselves on which states have a
prescription monitoring system and the
rules regarding its use.

11. 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.

12. 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.

13. 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.

14. Methadose 40 mg tablets

15. 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.

16. Hall’s profit potential

18. 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.

19. URGENT CARE SERVICES
 Based in Slidell, Louisiana

20. Investigative Strategy
concerning Urgent Care
Services

21. 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.

22. 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.

23. D.O. Randy Weiss

24. D.O. Stan Naramore

25. D.O. Stan Naramore

26. 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.

27. Results

28. Urgent Care Services
Stephen Lyon Tonia Snook

29. 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.

30. Urgent Care Services
Michael Leman

31. 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)

32. Stark also charged
 Stark was charged in our UCS
Conspiracy, has pled guilty and
received a 24 month sentence.

33. Then comes South Florida

34. Trend shifts and Kentucky folks
move to warmer climates

35.  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.

36. Strategy

37. Kentucky’s response to pill surge
from Florida

38. Clinics
 Florida Global Medical
 Lauderhill Medical Clinic
 American Pain

39. WSVN channel 7 in Ft.
Lauderdale, Florida news clip
11/10/2008

41. KSP photos of Americas
Pharmacy

42.  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.

43. 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.

44. Marsillett DTO

45. 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.

46. 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.

47. 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.

48. Lauderhill Medical Clinic –
Oakland Park, Florida

49. Dr. Michael Shook
Shook stated he made over $300,000 for year 2009

50. Michael Shook M.D.
 May 2011 Michael Shook was
sentenced to 48 months in prison.

51. Stand by more to come
 We have several cases ready to indict
concerning pill mill investigations using
these same type investigative
stratiegies.

52. Ouestions???
AUSA Roger West
Lexington, KY
859-685-4895
Roger.west@usdoj.gov