· One count of
unlawfully conspiring to distribute and dispense, and to cause to be
distributed and dispensed controlled substances, other than for a legitimate
medical purpose and not in the usual course of professional practice, resulting
in the death of six (6) of his patients;
· Three counts
of unlawfully distributing and dispensing controlled substances, including
fentanyl, oxycodone, and tapentadol, each
resulting in the death of a patient;
· 144 counts of
unlawfully distributing and dispensing controlled substances, other than for a
legitimate medical purpose and not in the usual course of professional
practice;
· Two counts of
conspiracy to commit healthcare fraud; and
· 16 counts of
healthcare fraud.
The counts alleging unlawful controlled substance
distributions resulting in death carry a mandatory minimum term of 20 years and
a maximum of life imprisonment, a $1,000,000 fine or both. The remaining drug distribution counts carry
maximum penalties, which, depending on the substance involved, range from one
to 20 years imprisonment. While the
maximum penalties for the healthcare fraud charges, vary between 10 years to
life imprisonment.
The indictment alleges that in carrying out the conspiracy,
Dr. Gosy and his employees at the Gosy Center, which included nurse
practitioners and physician assistants working under Dr. Gosy’s direction and
control, issued more prescriptions for controlled substances annually than any
other prescriber or prescribing entity in New York State, including
hospitals. Specifically, the indictment
alleges that Dr. Gosy and his employees carried out their conspiracy by:
· prescribing
controlled substances without conducting a physical examination and/or after conducting
only a limited and inadequate physical examination;
· prescribing
controlled substances in ways that were likely to cause, and did cause,
dependence and addiction, and that contributed to existing addictions;
· issuing
prescriptions for controlled substances in dosages and/or in combinations
dangerous to the health and safety of the patient;
· issuing
prescriptions for controlled substances despite indications that patients were
abusing and misusing the prescribed controlled substances;
· prescribing
controlled substances without monitoring or using objective treatment
information;
· recommending
a course of treatment, including the prescription of controlled substances, which
caused patients to become so addicted to opioid drugs that some eventually
utilized heroin and other street drugs, in order to satisfy their addiction;
· issuing
prescriptions for controlled substances to patients despite knowing that such
patients had overdosed, or had otherwise been hospitalized for conditions
relating to misuse of controlled substances;
· continuing to
prescribe controlled substances in the same manner, and failing to adapt
practices to prevent additional deaths and overdoses, despite having notice
that treatment they were following had resulted in obvious drug-seeking
behavior and addiction; numerous patient overdoses; and patient deaths;
· signing death
certificates, in the absence of an autopsy or medical examination, for deceased
patients to whom Gosy and/or his employees had prescribed controlled substances
despite aberrant behaviors;
· recommending
a course of treatment, including the prescribing of controlled substances,
which caused the death of at least six individuals, and contributed to the
deaths of others;
· utilizing a
telephonic patient prescription renewal process, whereby patients could obtain
prescriptions for Schedule II, III and IV controlled substances that were
prepared by persons who were not medically trained and issued by mid-level
providers who had inadequate knowledge about the prescription and the patient,
and without adequate review of the prescription and the
· Dr. Gosy
pre-signing blank prescriptions and permitting other persons to fill out the
remaining information for the prescription, when he would leave the Buffalo
area for extended periods;
· Dr. Gosy
failing properly to review and sign his own patient file notes, and arranging
for other, non-medical, personnel to sign said patient file notes, to make it
appear as if he had reviewed them;
· Dr. Gosy failing properly to review patient
file notes/reports prepared by mid-level providers working under his
supervision and working in collaboration with him, and arranging for other,
non-medical, personnel to sign said patient file notes, to make it appear as if
he had reviewed them;
· failing adequately to review records
provided to the office from other providers, and failing to obtain a complete
patient history and information about present illness and conditions;
· prescribing
controlled substances to individuals while failing to refer the patient to
and/or ensure compliance with drug addiction treatment despite aberrant
behaviors, and requests from patients and/or their family members for help with
addiction;
· prescribing
methadone to individuals exhibiting aberrant behaviors, outside of a methadone
clinic setting, and without employing additional safety precautions or
referring the patient to addiction treatment;
· Dr. Gosy,
beginning in 2008, circumventing state and federal regulations by prescribing
buprenorphine for the treatment of narcotics addiction, improperly using his
regular DEA number, and sometimes labeling the prescriptions as for “pain
management,” even when the drug was being prescribed primarily for the purpose
of treating narcotics addiction;
· Dr. Gosy
issuing prescriptions to patients for buprenorphine, a Schedule III controlled
substance, for the treatment of narcotics addiction, without having completed
the required medical training course in order to be a “qualifying physician” to
treat narcotics addiction;
· Dr. Gosy
failing to complete training requirements, including Continuing Medical
Education courses, Worker’s Compensation training, and Infectious Disease
Control training, and instead requiring members of his office staff to take the
online courses purporting to be the defendant; and
· Dr. Gosy
engaging in prescribing patterns whereby high-risk patients that had run out of
their prescribed opioids were given buprenorphine until Dr. Gosy could again
prescribe other opioids.
According to the indictment, other practices adopted and
used in defendant Gosy’s office included the following:
· Mid-level
providers (Physician Assistants and Nurse Practitioners) were encouraged to
maximize volume of patients seen. Providers who saw certain volumes of patients
received monetary bonuses, and/or gifts.
Providers who saw less patients were threatened with pay cuts. Providers also earned credit towards bonuses
for performing certain, more lucrative procedures on patients.
· Beginning in
2012, a “script line” was established which allowed patients seeking
prescriptions, who were not scheduled for an office visit, to call and request
a prescription. The “script line” was attended to by individuals with no
medical training or certification. They were responsible for drafting the
requested prescriptions with the proper drug and dosage, checking the patient’s
file for “alerts,” and the New York State iStop program, a Prescription
Monitoring Program. Each week a mid-level provider was designated to sign all,
or almost all, prescriptions requested through the “script line.” This
typically amounted to hundreds of prescriptions per day, many of which were for
patients whom the practitioner had never seen and/or with whom the practitioner
had little or no familiarity.
· A system was
in place for ordering urine drug tests whereby, once the test was ordered, an
employee other than the treating practitioner would typically fill out the
request form for the laboratory. As a result, the drug screens often tested for
the presence or absence of drugs other than those actually prescribed to the
patient. However, as part of the usual course of medical practice, urine drug
tests should have been ordered and reviewed in consultation with the patient’s
medical file, including history and list of current prescribed
medications. This is because urine drug
testing provided valuable objective information to assist in diagnostic and
therapeutic decision making, provided confirmation of compliance with the
treatment plan, and provided indication of overutilization of prescribed drugs,
diversion/non-use of prescribed drugs, the use of prescription drugs not
prescribed to a particular patient, and/or the use of alcohol or illicit street
drugs.
· As with the
“script line,” toxicology results, including urine drug screens, were reviewed
by a mid-level provider, many of whom had never seen the patient and/or with
whom the practitioner had little or no familiarity. As a result, tests were
often labeled as “consistent,” and not given appropriate attention, even when
the tests showed the presence of a non-prescribed drug, or the lack of a
prescribed drug.
· Patient
records often contained incorrect or insufficient information to justify a
diagnosis and warrant treatment. Mid-level providers frequently dictated their
office notes, failed to review their notes after transcription, and “batch
signed” large quantities of notes without review. In addition, Dr. Gosy rarely,
if ever, signed his own notes, and arranged for others to affix his signature
to office notes and patient files, in order to facilitate more expeditious
billing.
“Today’s superseding indictment represents the first time
that a physician in the Western District of New York has been alleged to be
criminally responsible for unlawfully prescribing drugs which resulted in the
death of a patient,” noted Acting U.S. Attorney Kennedy. “Sadly, the
superseding indictment alleges that more than one patient succumbed to the
inadequate and unlawful treatment they received at the hands of Dr. Gosy and
those who worked for him. While today’s
indictment does not represent a panacea, it does provide a powerful antidote
directed at one of the root causes of the opioid epidemic.”
DEA Special Agent-in-Charge James Hunt stated, “At the
height of diverted prescription drug abuse, Dr. Gosy’s clinic prescribed more
controlled substances than several major New York Hospitals, and is now being
charged with causing the death of six individuals. Today’s charges cannot bring
back the lives of those who died, but is a message to traffickers and rogue
doctors that their actions have irrevocable consequences. The DEA’s highest priority is arresting and
dismantling the largest opioid traffickers, Dr. Gosy being one of them.”
"The grand jury's superseding indictment exposes Gosy's
lack of concern for the true health of his patients," said FBI Special
Agent-in-Charge Adam S. Cohen. "Gosy did not work to heal all of those who
struggled with pain, rather he betrayed his patients’ trust by putting his own
personal gain ahead of their health and well-being. The FBI is committed to
working with our partners on the front lines of the fight against heath care
fraud and opioid addiction."
“Prescription drug fraud is a crime fueled by greed that
damages this country, community by community. We rely on doctors to be part of
the prescription drug abuse solution – not part of the problem,” said Special
Agent-in-Charge Scott J. Lampert of the HHS Inspector General’s New York
Office. "Today’s indictment shows
our determination to work closely with our law enforcement partners to hold
irresponsible doctors accountable for their actions."
The superseding indictment is the result of an investigation
by the Drug Enforcement Administration, under the direction of James J. Hunt,
Special Agent-in- Charge, New York Field Division; the Federal Bureau of
Investigation’s Western New York Health Care Task Force, under the direction of
Special Agent-in-Charge Adam S. Cohen; the Department of Health and Human Services,
Office of Inspector General, under the direction of Special Agent-in-Charge
Scott Lampert; the Army National Guard - New York National Guard Counterdrug
Task Force, under the direction of Lt. Col. Nicholas Dean; the New York State
Department of Financial Services, under the direction of Maria T. Vullo, Acting
Superintendent; the New York State Office of the Workers’ Compensation Fraud
Inspector General, under the direction of Inspector General Cathy Leahy Scott;
and the New York State Bureau of Narcotics Enforcement.
The case was presented to the grand jury by Assistant United
States Attorneys Maura K. O’Donnell and Patricia Astorga, who together are
prosecuting the case for the United States.
