Dr. Eugene Gosy, 60, of Clarence, NY, who was convicted of conspiracy to distribute controlled substances and healthcare fraud, was sentenced to serve 70 months in prison by Chief U.S. District Judge Frank P. Geraci, Jr.
“The Hippocratic Oath requires physicians to do no harm,” noted U.S. Attorney Kennedy, “and the defendant’s crimes in this case—prescribing drugs outside the reasonable practice of medicine and without a legitimate medical purpose and healthcare fraud—clearly did harm to certain of his patients and to our healthcare system. But this prosecution—and the public debate it sparked—also brought with it an unintended benefit in helping to diagnose and identify some of the underlying conditions and factors which may have contributed not only to defendant’s crimes but to the larger opioid crisis generally. From a healthcare system, which, in 2001, decided to treat pain as a 5th vital sign, thereby incentivizing a surge in opioid prescriptions; to a pharmaceutical industry, which developed and aggressively marketed powerful opioids, all the while minimizing their risks and exaggerating their benefits; to an educational system, which failed appropriately to educate and train healthcare professionals regarding all of the dangers or these powerful drugs and how to deal with patients suffering from addiction; to a medical community, which was too willing to refer its most difficult cases and problematic patients to a single provider who was perhaps too willing to take them; to a criminal justice system, which was slow to recognize that it would be unable simply to arrest its way out of the problem—there is, when it comes to the opioid crisis, plenty of blame to go around. But this prosecution is not about blaming anyone. My Office does not prosecute people; we prosecute violations of federal law. Today’s sentence simply holds one person—Dr. Eugene Gosy—responsible for the criminal violations of federal law he committed. Nothing more. Nothing less.”
“Opioid fraud schemes have devastated many communities around this country. Today’s sentencing demonstrates our commitment to hold accountable individuals whose reckless prescribing pose a danger to the public and contribute to the ongoing opioid epidemic,” said Special Agent-in-Charge Scott J. Lampert, of the U.S. Department of Health and Human Services, Office of Inspector General, Office of Investigations’ New York Region. “In coordination with our law enforcement partners, we will use all available resources to thoroughly investigate crimes involving opioids and other prescription drugs.”
“Our investigation into Dr. Gosy’s role in the illegal proliferation of pain medication at the height of opioid epidemic was vindicated by his guilty plea, earlier this year,” stated DEA Special Agent-in-Charge Ray Donovan. “Today’s sentencing emphasizes law enforcement’s commitment to saving lives by investigating, arresting, and prosecuting those responsible for fueling opioid addiction and overdoses.”
“Gosy’s plea laid bare his criminal indifference to the well-being and health of many of his patients and their families,” said Stephen Belongia, Special Agent-in-Charge of the FBI’s Buffalo Office. Gosy’s practice of medicine placed a higher value on profit through fraud than the fragile lives of those who came to him for help. After his arrest, many expressed support for Gosy believing his treatments were based on good judgment and sincerity, but investigation revealed and his plea prove this was not the case. There is no doubt that Gosy exploited his patients’ pain for profit, at a tragic cost. This case demonstrates the importance of protecting patients suffering from chronic pain from those willing to capitalize on their suffering.”
Assistant U.S. Attorneys Brendan T. Cullinane, Jonathan P. Cantil, and Charles J. Volkert, who handled the case, stated 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, 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 patient’s chart;
- 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.
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.
The sentencing is the result of an investigation by the Department of Health and Human Services, Office of Inspector General, under the direction of Special Agent-in-Charge Scott Lampert; the Drug Enforcement Administration, under the direction of Ray Donovan, 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 Stephen Belongia; 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 Superintendent Linda A. Lacewell; the New York State Office of the Workers’ Compensation Fraud Inspector General, under the direction of Inspector General Letizia Tagliafierro; and the New York State Bureau of Narcotics Enforcement.