Doctor caught sits at the center of this dementia and brain health question.
Doctors across the United States are being caught prescribing opioids — most frequently oxycodone — without any legitimate medical reason, and the consequences are finally catching up with them. In March 2026, Dr. Roya Jafari-Hassad of Great Neck, New York, was sentenced to seven years in federal prison for running an oxycodone pill mill out of her medical office. She had been convicted on eight counts of prescribing oxycodone without a legitimate medical purpose and was ordered to pay a $150,000 fine along with $152,765 in restitution. Her case is not an outlier.
It is part of a disturbing pattern of physicians exploiting their prescribing authority for profit, sometimes with fatal results. The problem extends well beyond a single rogue doctor on Long Island. From Pennsylvania to Iowa to New Jersey, federal and state prosecutors have secured guilty pleas, prison sentences, and license surrenders against physicians who treated their prescription pads like ATMs. In one of the most sweeping enforcement actions, the DEA’s “Operation Profit Over Patients” resulted in approximately 51 arrests and 122 criminal charges against doctors, nurse practitioners, and pharmacists who wrote unnecessary prescriptions for large quantities of opioids including oxycodone, hydrocodone, hydromorphone, and fentanyl. This article examines the most notable recent cases, explains how these schemes operate, what legal standards prosecutors must meet, and what patients and families — particularly those caring for older adults with cognitive decline — should watch for.
Table of Contents
- Why Are Doctors Being Caught Prescribing Opioids Without a Legitimate Medical Purpose?
- How Pill Mills Operate and Why They Are Hard to Stop
- When Illegitimate Prescribing Turns Deadly
- What Patients and Families Should Watch For
- The DEA’s Expanding Enforcement and Its Limits
- Financial Settlements and Civil Consequences
- What Comes Next for Prescribing Oversight
- Conclusion
- Frequently Asked Questions
Why Are Doctors Being Caught Prescribing Opioids Without a Legitimate Medical Purpose?
The short answer is money. Illegitimate prescribing schemes almost always follow a financial motive, whether it comes from cash payments from patients seeking pills, kickbacks from pharmacies, or fraudulent billing submitted to Medicare and Medicaid. Dr. Neil K. Anand of Pennsylvania was sentenced to 14 years in federal prison — one of the longest sentences in recent prescribing fraud cases — for conspiracies involving health care fraud, wire fraud, unlawful distribution of controlled substances, and money laundering. Anand distributed what prosecutors called “Goody Bags” of medically unnecessary prescription medications through in-house pharmacies he owned, effectively creating a vertically integrated fraud operation where he wrote the prescriptions and then filled them himself for maximum profit. In new Jersey, Dr. Eugene Evans Jr.
of Roselle Park took a more direct approach. He conspired with a drug dealer to write fraudulent oxycodone prescriptions for thousands of high-dose pills intended for people he had never treated or even examined. Evans pleaded guilty to second-degree distribution of a controlled dangerous substance and faces a five-year prison sentence. The case illustrates how some physicians abandon even the pretense of a doctor-patient relationship, functioning instead as narcotics distributors with medical degrees. These cases are not victimless financial crimes. The pills these doctors prescribe end up on the street, fuel addiction, and kill people. The opioid crisis has claimed more than half a million American lives since 1999, and illegitimate prescribers are a significant part of the supply chain. For families managing dementia care, the danger is compounded — older adults with cognitive impairment are particularly vulnerable to inappropriate prescribing because they may not be able to advocate for themselves or question a medication they are given.
How Pill Mills Operate and Why They Are Hard to Stop
A pill mill typically looks like a legitimate medical practice from the outside. The doctor maintains an office, sees patients, and writes prescriptions that are filled at real pharmacies. What distinguishes a pill mill from a legitimate pain management practice is the absence of genuine medical evaluation. Patients may be seen for only a few minutes, receive no physical examination, undergo no diagnostic testing, and leave with prescriptions for large quantities of controlled substances every time they visit. Dr. Jafari-Hassad’s Great Neck operation followed this model — she also pleaded guilty to health care fraud in April 2025, indicating that she was billing insurers for services she was not meaningfully providing. However, drawing the line between aggressive pain management and criminal prescribing is not always straightforward. The U.S.
Supreme Court addressed this difficulty in its June 2022 ruling in Ruan v. United States, holding that prosecutors must prove a doctor knowingly misprescribed opioids for it to constitute a federal crime. Mere negligence — even reckless prescribing — is not enough. The doctor must have subjectively known or intended that they were acting outside the bounds of legitimate medical practice. This decision raised the bar for prosecution considerably and means that cases reaching trial tend to involve the most egregious conduct, where intent is difficult to dispute. This legal standard creates a gray zone that some physicians exploit. A doctor who writes too many opioid prescriptions out of genuine, if misguided, compassion for patients in pain occupies different legal territory than one who is clearly running a for-profit pill operation. Prosecutors and regulators must build cases carefully, which is one reason why these investigations often take years. For patients and families, this means that a problematic prescriber may continue operating for a significant period before enforcement catches up.
When Illegitimate Prescribing Turns Deadly
The most tragic outcomes of illegitimate prescribing involve patient deaths, and prosecutors are increasingly willing to bring manslaughter charges against doctors whose prescribing kills. Dr. Richard Miron of Dracut, Massachusetts, an 83-year-old physician, pleaded guilty on November 17, 2025, to involuntary manslaughter for illegally prescribing opioids to an at-risk patient whose death resulted from those prescriptions. He also faced charges of illegal prescribing and Medicaid false claims. The case is a stark reminder that age and long careers in medicine do not insulate a doctor from accountability when their prescribing causes harm. Miron’s case is particularly relevant for families navigating dementia care and elder health.
At-risk patients — a category that includes older adults with multiple health conditions, those with a history of substance use, and people with cognitive impairment — require more cautious prescribing, not less. A doctor who ignores risk factors and prescribes opioids anyway is not just committing a regulatory violation. they are gambling with their patient’s life. When that gamble fails, involuntary manslaughter charges reflect the seriousness of the harm. The willingness of prosecutors to pursue manslaughter charges also sends a signal to the broader medical community. Doctors cannot hide behind their licenses when their prescribing practices are reckless. The penalty structure for illegitimate prescribing is severe and growing: license suspension or revocation, civil fines ranging from $120,000 to more than $300,000, federal prison sentences of five to fourteen years or more, and restitution payments that can reach into the hundreds of thousands of dollars.
What Patients and Families Should Watch For
Recognizing the warning signs of illegitimate prescribing is not always intuitive, especially for families who trust their loved one’s doctor. But certain patterns should raise concern. If a physician prescribes opioids without conducting a thorough examination, does not order imaging or lab work to support a pain diagnosis, resists referrals to specialists, or prescribes escalating quantities without exploring alternative treatments, those are red flags. Dr. Troy Adolfson of Ankeny, Iowa, surrendered both his South Dakota medical license and his DEA license after being criminally charged with felony narcotics distribution for writing oxycodone prescriptions — 60 to 140 pills at a time — for a co-worker and two other people. The Iowa Board of Pharmacy reviewed his case in January 2026. The sheer volume of pills per prescription was itself a warning sign.
There is a tradeoff that families must navigate carefully. Pain is real, undertreated pain is a serious quality-of-life issue for older adults, and not every opioid prescription is inappropriate. The goal is not to be suspicious of all pain management but to ensure that prescribing follows established medical standards. Legitimate pain management involves documentation of the condition being treated, regular reassessment, consideration of non-opioid alternatives, and monitoring for signs of misuse or adverse effects. When these safeguards are absent, the prescribing may not be in the patient’s interest. For someone caring for a parent or spouse with dementia, the stakes are higher. A person with significant cognitive impairment may not be able to report side effects, may not remember taking a dose and take another, or may not understand what they are being prescribed. Family members and caregivers serve as the last line of defense, and asking questions about why a particular medication is being prescribed and whether alternatives exist is not only reasonable — it is necessary.
The DEA’s Expanding Enforcement and Its Limits
The DEA’s “Operation Profit Over Patients” represents the most aggressive federal posture toward illegitimate prescribers in recent years. The operation targeted physicians, nurse practitioners, and pharmacists across the country, resulting in roughly 51 arrests and 122 criminal charges. The focus was on practitioners who wrote unnecessary prescriptions for large quantities of opioids, including some of the most dangerous drugs in the controlled substance schedule: oxycodone, hydrocodone, hydromorphone, and fentanyl. These operations involve extensive surveillance, review of prescription drug monitoring program data, undercover operations, and cooperation between federal and state agencies. However, enforcement alone cannot solve the problem.
For every doctor arrested, others continue prescribing improperly, and the legal threshold established by the Supreme Court in Ruan means that only the most blatant cases are likely to result in criminal convictions. Civil enforcement — license actions by state medical boards, administrative fines, and exclusion from Medicare and Medicaid — picks up some of the cases that do not rise to the level of criminal prosecution, but state medical boards have been widely criticized for being slow and opaque in their processes. There is also a geographic limitation. The cases that make national news tend to be concentrated in areas with active federal prosecutors and well-resourced DEA field offices. In rural areas, where physician access is already limited, regulators face a genuine dilemma: removing a doctor who prescribes improperly may leave a community with no doctor at all. This does not excuse illegitimate prescribing, but it does explain why some cases take longer to resolve than the public might expect.
Financial Settlements and Civil Consequences
Not all cases of improper prescribing end in criminal prosecution. Some are resolved through civil settlements that impose significant financial penalties without a prison sentence. In January 2026, an El Paso doctor entered a $200,000 settlement following state and federal fraud allegations related to improper prescribing.
Civil settlements often include requirements that the physician surrender their DEA registration, submit to practice monitoring, or agree not to prescribe controlled substances in the future. These settlements serve a dual purpose: they remove or restrict the prescriber’s ability to cause further harm, and they recover some of the financial damage caused by fraudulent billing. For patients and families, a civil settlement may feel like an insufficient consequence, but it often achieves the practical outcome of stopping the harmful behavior more quickly than a criminal prosecution that can take years to reach resolution.
What Comes Next for Prescribing Oversight
The enforcement landscape is shifting toward greater scrutiny of prescribing patterns through technology and data analysis. Prescription drug monitoring programs, which track controlled substance prescriptions across state lines, are becoming more integrated and more aggressively used by both regulators and law enforcement. Artificial intelligence tools are being deployed to identify statistical outliers — doctors whose prescribing volume, pill counts, or patient demographics diverge significantly from their peers.
For families managing brain health and dementia care, these developments offer cautious reason for optimism. Better data means earlier detection of problematic prescribers, which means fewer patients harmed before intervention occurs. But the fundamental responsibility remains with patients, families, and caregivers to ask questions, seek second opinions when something feels wrong, and report concerns to state medical boards or the DEA’s Diversion Control Division. No enforcement system is fast enough to protect someone who is being harmed right now — that protection starts with the people closest to the patient.
Conclusion
The cases of doctors like Jafari-Hassad, Anand, Miron, Evans, and Adolfson are not isolated incidents. They represent a systemic vulnerability in American medicine — the reality that a prescribing license, combined with insufficient oversight, can become a tool for fraud, addiction, and death. The penalties are severe and growing more so, with prison sentences reaching 14 years, fines exceeding $150,000, and the permanent destruction of medical careers. The Supreme Court’s requirement that prosecutors prove knowing misconduct has raised the bar for criminal cases, but the most egregious offenders are still being caught and punished.
For anyone caring for an older adult, particularly someone with cognitive decline, the takeaway is practical: stay involved in your loved one’s medical care, question prescriptions that seem unnecessary or excessive, and do not assume that a doctor’s authority is the same as a doctor’s integrity. Legitimate physicians welcome questions from engaged family members. If a prescriber resists scrutiny, that itself is a warning sign worth acting on. Report concerns to your state medical board or the DEA, and do not wait for someone else to raise the alarm.
Frequently Asked Questions
What is a pill mill?
A pill mill is a medical practice — sometimes a doctor’s office, sometimes a clinic — where controlled substances, usually opioids, are prescribed without a legitimate medical purpose. Patients typically receive little or no examination, and prescriptions are written in exchange for cash or to generate fraudulent insurance billing.
How can I tell if my family member’s doctor is prescribing opioids inappropriately?
Warning signs include very short appointments with no physical examination, prescriptions for large quantities of opioids (60 or more pills at a time), no diagnostic workup to support the prescription, resistance to referring the patient to a pain specialist, and no discussion of non-opioid treatment alternatives.
What should I do if I suspect a doctor is prescribing without a legitimate medical purpose?
You can report concerns to your state medical board, the DEA’s Diversion Control Division, or the HHS Office of Inspector General. If you believe a family member is in immediate danger from a medication, contact another physician or go to an emergency room.
What are the typical penalties for doctors caught prescribing illegitimately?
Penalties include license suspension or revocation, civil fines ranging from $120,000 to more than $300,000, federal prison sentences of 5 to 14 or more years, and restitution payments. In cases where a patient dies, involuntary manslaughter charges are increasingly common.
Does the Supreme Court’s Ruan decision make it harder to prosecute pill mill doctors?
The 2022 Ruan v. United States decision requires prosecutors to prove that a doctor knowingly misprescribed, not merely that they were negligent. This raises the evidentiary bar, but cases involving blatant fraud — prescribing to people never examined, conspiring with drug dealers, or operating dedicated pill mills — still result in successful prosecutions.
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For more, see NIH MedlinePlus — cognitive testing.
