PAs and NPs are essential components of medical care in many areas, working with physicians on lower acuity patients and freeing the MDs and DOs to deal with more serious problems. While they have many powers, such as completing physical examinations, diagnosing, and prescribing, physician assistants (PAs) are required to have a portion of their charts reviewed by a physician. Many years ago, I was asked to review charts for a nurse practitioner in a rural area of the state. At the time, I was running a busy primary care clinic, but as the elderly doctor in that town was retiring, I was happy to help. A while later, I got a call from a pharmacy in another state asking about a compounded medication. I was positive I had not ordered this, but the pharmacist insisted that I phoned in prescriptions there all the time. I asked for copies of these and was stunned to see that someone was using my name and information to call in prescriptions.
One guess who it was. The nurse practitioner had lost prescribing privileges and, since they had all of my information, had started impersonating me to keep their clinic open. I called the DEA and reported everything, just as I’ve related here. To the best of my knowledge, the practitioner was dealt with and did not go to trial, as I did not have to testify. But what could have happened? The DEA could have offered the practitioner a sweet deal to say that I had been involved, only if it’s “true” of course. It doesn’t take most people long to figure out the phraseology. And convicting a doctor has become a very popular thing in federal law enforcement. What could have happened to me, did happen to someone else. Dr. Sasaki had taken a brief telemedicine job with PAs who needed their charts reviewed remotely. This paid Dr. Sasaki only $5/chart. But the hours could be flexible while he focused on other matters in his life. Unknown to Dr. Sasaki, however, these PAs ran a side business, using the credentials of the supervising doctors to call in and fax fake narcotic prescriptions.
These prescriptions were sold over the Internet to those seeking drugs. Although Dr. Sasaki didn’t know what was actually going on, he became suspicious after another doctor told him that something was wrong, and he started to look for anything that wasn’t right. He then came across a chart that had a prescription purportedly from “Dr. Terry Sasaki” with the DEA number, “Dr. Sasaki”, and a clearly pixelated signature that did not include “MD”. A further review noted that these signatures were identical on several fraudulent prescriptions he found. Most pharmacists would never fill such a prescription, but one, Dr. Vinesh Darji, had been part of the conspiracy. This pharmacist had made millions of dollars doing this, and the PAs were compensated for their participation, despite, or perhaps because of, having had previous run-ins for fraud in the past. After his experience with his residency, Terry didn’t know who to trust. Definitely no one in that company. So he reached out to the US Federal government in the form of the DEA. The DEA agreed to meet with him but told him he could not bring an attorney unless he was guilty. And while he brought a tape recorder to the meeting, this was confiscated before the interview, but he was told that the DEA would record it and give him a copy of the tape. Dr. Sasaki’s father had served in the military, and he had been raised to have a high level of respect for the government.
There were the good guys. After the more than two-hour meeting, the DEA told Dr. Sasaki that he had done nothing wrong and they would protect him as a confidential informant. The DEA instructed Dr. Sasaki NOT to disassociate with the company to avoid alerting the guilty to the investigation. This was 2007. In 2008, the DEA renewed and expanded Dr. Sasaki’s ability to prescribe narcotics. Then, in a stunning betrayal, the DEA unexpectedly indicted and arrested Dr. Sasaki, claiming he had “confessed” at that meeting in 2007. The DEA denied that meeting was recorded. Of the five DEA employees in the room while Dr. Sasaki had told them what he knew, only one of them said he confessed. That agent, Parkison claimed to have been the “notetaker”, but his own supervisor, who was in the room, later testified that another agent, Joseph Cox, was actually the notetaker. Parkison had three versions of notes. The first did not say anything about Dr. Sasaki confessing, then a later set had some names crossed out and replaced with other names, and finally, a third set was produced much later – clearly created to implicate Terry.
Investigator Cox’s notes contradicted those of Parkison’s and only Parkison out of the five DEA employees in the room said that Parkison had taken any notes at all. No one asked why they wouldn’t get Dr. Sasaki’s signature on a confession if one was actually given. The pharmacist Vinesh Darji, who made well over a million dollars, later testified that he never tried to communicate with Dr. Sasaki in any form or fashion. Parkison’s testimony on the stand was also filled with verifiable lies, such as that Dr. Sasaki’s original signatures and DEA number were on the conspiracy prescriptions when they clearly were not. But it turned out that as long as people, including Dr. Sasaki, went to prison, Parkison got promotions. Now let’s review a few facts. Terry had made about $5 per chart he reviewed for the PAs which was never related to the money that the PAs got on the side for narcotic prescriptions.
The bank records clearly showed that he made no money from the conspiracy. When discovery finally arrived, there was nothing from the company implicating Dr. Sasaki. In fact, the main doctor who pled guilty and was cooperating with the government who WAS in on the conspiracy had testified that he never prescribed when associated with Dr. Sasaki and that Dr. Sasaki had actually warned him NOT to prescribe narcotics over the internet because it was illegal. They had just used Dr. Sasaki’s name to spread the prescriptions over more doctors’ names to avoid scrutiny. Dr. Sasaki was not on or even mentioned in any of the more than 3,000 wiretaps recorded by the government. Terry went to trial because he was innocent. But that was not enough. Based solely on the “confession” Parkison claimed he had been given, Terry was prosecuted and convicted as if he were a leader in the conspiracy.
Despite the real conspirators, Hazelwood and Darji denying ever even speaking or communicating with Terry. The PAs who stole Dr. Sasaki’s credentials also made over $1 million but were never arrested or had to testify. Then, there were digital records. It turned out that anyone who had access to the computer system could send prescriptions in doctors’ names without any notice going to that physician. The metadata from this system would clearly show who had ordered what from which computer. But the Department of Justice blockaded the defense from accessing this information. No prescription had Dr. Sasaki’s actual signature, and the government had no handwriting expert willing to testify that it was. The prescriptions had someone else’s telephone number on them. Not tied in any way to Terry.
Not a single one had Dr. Sasaki’s DEA number on it. DEA agent Parkison even admitted that Dr. Sasaki had never logged in to the prescriptions system; therefore he could not possibly have pressed the “Approve” button. Another doctor, who admitted to being part of the conspiracy, admitted that HE had pressed the approve button every time. This seems like insurmountable evidence of innocence. But the DEA had their trump card. An agent willing to say that Dr. Sasaki, “confessed” to him. Perhaps, in order to excuse their own inaction for three years, the DEA needed a scapegoat, and Dr. Sasaki was the perfect patsy because he had taken no actions to protect himself from wrongful prosecution. The DEA could conflate his reporting a crime into a confession, creating notes that said whatever they wanted.
The DEA gets awards and promotions for putting doctors in prison and Dr. Sasaki was low hanging fruit. PMP’s were just coming into existence at that time and even now are limited by state. And there is no “fraud” alert mechanism except to notify the DEA, which is exactly what Dr. Sasaki did. Dr. Sasaki did the only thing he thought he could do in this situation, which was to notify the authorities. But in fact, he should have gotten an attorney. There are many things I don’t like about the legal profession, but the advice to never trust or talk to law enforcement is worth its weight in platinum. There is a war being waged today, between doctors who want to practice medicine, and federal agents, who, with no medical training whatsoever, want to dictate medical practice to physicians.
The Department of Justice and federal courts also rely on experts, like in Dr. Sasaki’s case, but these are not actually experts or even in the mainstream. They just parrot whatever party line supports the government’s charges. Dr. Sasaki is collateral damage, in a battle to indict and convict as many doctors as possible, regardless of guilt. It would be wise for every healthcare provider to keep this in mind. Be reluctant to release all of your credentials. Get NDAs signed when appropriate. And run a reverse PMP check to see what is going out in your name. And above all, get an attorney to mediate any contact with federal authorities.
