Welcome to Spodek Law Group. Our goal is to give you the reality of DEA registration actions - not the sanitized version the government presents, not the hopeful fiction that everything will work out, but the actual truth about what happens when the DEA comes after your ability to prescribe controlled substances. Because what most healthcare providers dont realize until its too late is this: the DEA's administrative machinery is designed to make you lose your license BEFORE your hearing ever happens.
That sounds dramatic. It isnt. The Drug Enforcement Administration has authority under 21 U.S.C. 824(d) to issue something called an Immediate Suspension Order. This power allows them to suspend your DEA registration simultaneously with the Order to Show Cause - meaning you lose your ability to handle controlled substances TODAY, not after some hearing, not after some appeal, but right now while your reading this terrified wondering what went wrong.
The system is set up this way deliberately. And if you dont understand exactly how it works, you will make decisions in the next 30 days that destroy your career permanently.
What The DEA Actually Sends You (And What It Really Means)
When the DEA decides to take action against your registration, they have two primary weapons. The first is an Order to Show Cause, which is basicly a formal accusation that gives you 30 days to request a hearing. The second - and this is were people dont understand the danger - is an Immediate Suspension Order that can be issued at the same time.
Heres the thing about immediate suspension. The DEA only needs to show by a preponderance of evidence that theres an "imminent danger to public health or safety." Not beyond reasonable doubt like in criminal court. Not even clear and convincing evidence. Just slightly more likely then not.
And the definition of "imminent danger" under the Controlled Substances Act? "Due to the failure of the registrant to maintain effective controls against diversion or otherwise comply with the obligations" under the CSA, "there is a substantial likelihood of an immediate threat that death, serious bodily harm, or abuse of a controlled substance will occur."
Notice what that definition doesnt require. It doesnt require that anyone actually died. It doesnt require that anyone was actually harmed. It requires a "substantial likelihood" that harm COULD occur. And the DEA gets to decide what that means.
What happens in practice is that you recieve a thick envelope - sometimes hand delivered by federal agents - containing allegations that you didnt even know existed. Prescribing patterns they've been tracking. Records discrepancies they found during an inspection you thought was routine. Patient complaints you never heard about. They built this case for months or years. You have 30 days to respond.
The 30-Day Trap That Destroys Careers
Thirty days. Thats what you get to request a hearing after receiving an Order to Show Cause. Miss that deadline and you waive your right to a hearing permanently. Not temporarily. Permanantly.
OK so think about what happens in those 30 days. Your in shock. Your trying to understand what the allegations even mean. Your trying to find an attorney who specializes in DEA administrative law - and there arent many. Your trying to figure out how to keep your practice running, or even whether you can. Your probably not sleeping. Your definately not thinking clearly.
And thats exactly when the DEA contacts you offering a different path. "What if you just voluntarily surrendered your registration? We could make this all go away. No hearing, no public record, no prolonged fight. Just sign here."
This is the trap.
Voluntary surrender isnt the easy way out. Its the worst possible outcome dressed up to look like mercy. When you voluntarily surrender your DEA registration, that surrender is reported to the National Practitioner Databank. It triggers automatic investigation by your state medical or pharmacy board. It can result in exclusion from Medicare and Medicaid programs. Your hospital privileges review it. Your insurance panels review it.
And heres were it gets even worse - in the 2024 Connecticut case involving physicians Shifreen and Norval, they voluntarily surrendered their registrations in March 2023 and payed $300,000 to settle allegations. The settlement terms? They cannot even APPLY for a new DEA registration for five years. Not that they'd be denied for five years - they cant even ask.
Let that sink in. Voluntary surrender sounds like your choosing to walk away. In reality your choosing permanent exclusion from the profession you spent decades building.
Why Voluntary Surrender Is Never The Easy Way Out
Todd Spodek has seen this pattern in hundreds of cases across federal administrative law. The government makes surrender look attractive precisly because they know it works in their favor.
Consider the alternative. If you fight and lose - genuinly go through the hearing process and get your registration revoked - yes thats terrible. But revocation after a hearing doesnt carry the same implications as voluntary surrender. You exercised your rights. You made the government prove their case. You have a record of what actually happened.
Voluntary surrender? Your admitting you did something wrong. Even if you never see a courtroom. Even if no criminal charges are ever filed. Even if the only evidence the DEA had was circumstantial at best.
The really cruel part is the timeline. Fighting takes time - the Office of Inspector General found that DEA adjudication can take MORE THAN ONE YEAR. And during that year, if you have an Immediate Suspension Order, you cannot handle controlled substances. Your practice is dying. Your patients are leaving. The financial pressure to just surrender and move on becomes almost unbearable.
This is by design. The longer the process takes, the more pressure builds on you to give up.
How The Hearing Process Actually Works (And Why The DEA Usually Wins)
Lets say you do what most attorneys would advise - you request the hearing within 30 days, you find specialized counsel, you prepare to fight. What actually happens next?
Your case goes to a federal Administrative Law Judge. This ALJ works for the DEA, but is supposed to be impartial. Both sides present evidence, call witnesses, make arguments. The ALJ issues a recommended decision.
Heres the kicker though. The recommended decision isnt final. The DEA Administrator reviews it. And the Administrator can REJECT, MODIFY, or ADOPT the ALJ's recommendation.
What this means in practise is that even if the ALJ sides with you - even if an independent judge looks at the evidence and says "no, the DEA hasnt met its burden" - the Administrator can override that decision. The Administrator, who is politically appointed, who faces pressure to look tough on the opioid crisis, who isnt bound by the ALJ's factual findings in the way a normal appellate court would be.
You can appeal the Administrator's final order to the United States Court of Appeals. You have 30 days from notice of the decision. But federal courts reviewing agency decisions give considerable deference to the agency - they're not relitigating the facts, they're looking for whether the decision was "arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with law." Thats a high bar.
At Spodek Law Group, we tell clients upfront: the hearing isnt really about proving your innocent. Its about proving your NOT a danger to public health. Thats the framing the statute creates. Your on defense from the moment you recieve that Order to Show Cause.
The Domino Effect Nobody Warns You About
Your DEA registration is connected to everything. This is the hidden architecture of medical practice that nobody explains until one piece falls and takes everything with it.
Loose your DEA registration and your state medical board or pharmacy board opens an investigation - sometimes automatic, sometimes triggered by mandatory reporting. Many state licensing statutes require reporting of federal actions. So now your fighting on two fronts.
Hospital privileges? Governed by bylaws that typicaly require disclosure of any federal enforcement action and often mandate suspension pending investigation. Your admitting privileges can disappear while your DEA case is still pending.
Insurance credentialing follows the same pattern. Insurers want nothing to do with providers under federal investigation. Your reimbursement streams dry up.
Medicare and Medicaid have their own exclusion processes. A DEA registration revocation - especially for controlled substance violations - can trigger exclusion from federal healthcare programs. Now you cant treat the elderly or the poor.
The cascade looks like this in real time:
Immediate Suspension Order → can't prescribe or dispense controlled substances → hospital suspends privileges pending investigation → insurance panels terminate contracts → patients find other providers → revenue drops to zero → staff leaves → practice closes → forced to surrender anyway → state board revokes license → Medicare exclusion → bankruptcy → divorce.
Ive seen this exact sequence play out. It happens faster then you think possible.
The Five Grounds The DEA Uses Against You
Under 21 U.S.C. 824(a), the DEA can suspend or revoke your registration based on five specific grounds. Understanding these matters because every defense strategy depends on which ground the DEA is using.
Ground one: materially falsifying your application. If you ommitted something on your DEA registration that the government considers material - even if you didnt think it was relevent at the time - that becomes a basis for revocation. Not just denial of renewal. Revocation of what you already have.
Ground two: felony conviction related to controlled substances. This seems obvious, but heres were it gets complicated. The statute covers "any law relating to controlled substances" - which is broader then just the Controlled Substances Act. State convictions count. Conspiracy convictions count. Things that happenned years ago can suddenly become relevent.
Ground three: state license suspension, revocation, or denial. If your state medical board or pharmacy board has taken action against your license - even temporarily, even pending investigation - the DEA can use that as a basis for federal action. This creates a circular nightmare were state action triggers federal action which triggers more state action.
Ground four: acts rendering registration inconsistent with the public interest. This is the catch-all, and its were most cases live. The DEA evaluates several "public interest factors": your compliance history, your controls against diversion, your state law compliance, prior convictions, and your experience distributing controlled substances. They weight these factors however they want.
Ground five: failure to maintain effective controls against diversion. Record-keeping violations, inventory discrepencies, prescription patterns that suggest diversion - all of this falls under ground five. And the DEA's definition of "effective controls" is whatever they say it is.
Most Order to Show Cause documents cite multiple grounds. They throw everything at you. And you have to defend against all of it simultaneously.
What Happens If You Do Nothing
Some providers recieve an Order to Show Cause and freeze. The paperwork is overwhelming. The allegations are terrifying. The deadline approches. And they dont respond.
Look at what happened to Just Here II Pharmacy in Philadelphia. The DEA issued an Order to Show Cause and Immediate Suspension in October 2024. The pharmacy defaulted - didnt respond, didnt request a hearing, didnt fight back.
The result? Under DEA regulations, when you default, all factual allegations in the Order to Show Cause are DEEMED ADMITTED. Everything the DEA claimed became true as a matter of law. No hearing, no evidence required, no opportunity to explain. The pharmacy was found to have failed to maintain accurate records of purchasing and dispensing controlled substances from September 2023 to March 2024.
Default isnt even the worst part. The final decision gets published in the Federal Register. This is permanent public record. Anyone searching your name, your pharmacy name, your practice name - they find it. Forever.
Doing nothing guarentees the worst outcome. At least if you fight you have a chance.
The Timeline Reality Of Fighting Back
If your going to fight, you need to understand what fighting actually looks like.
Day 1-30: You recieve the Order to Show Cause. You find an attorney. You file your request for hearing. If theres an Immediate Suspension, you potentially seek emergency injunctive relief in federal court.
Days 31-180: Discovery and preparation. Your attorney requests documents from the DEA, prepares witness lists, develops your defense theory. If your under Immediate Suspension, your practice is struggling or closed during this entire period.
Months 6-12+: The hearing itself, before the Administrative Law Judge. Multiple days of testimony. Evidence presentation. Post-hearing briefing.
After the ALJ recommends: The DEA Administrator reviews. This can take additional months. The Administrator issues a final order.
After final order: You have 30 days to appeal to the Court of Appeals. Federal court litigation can take another year or more.
Total timeline from Order to Show Cause to final resolution in court: often 2-3 years or more.
Now consider: if you have an Immediate Suspension Order, you cannot handle controlled substances for that entire period unless you obtain injunctive relief - which most courts are reluctant to grant. Can your practice survive 2-3 years without prescribing or dispensing controlled substances?
This is why so many providers surrender. Not becuase they're guilty. Because they cant survive the process even if there innocent.
When The DEA Offers You A Deal
Sometimes, during the Order to Show Cause process, the DEA offers settlement. A consent agreement. Modified registration. Civil monetary penalties instead of revocation.
As of February 2024, civil penalties are $18,759 for each recordkeeping violation and $80,850 for each prescription violation. If the DEA alleges you had 10 prescription violations, your looking at over $800,000 in potental fines.
Settlement can make sense in some cases. But never - and I mean never - accept a settlement without counsel who specializes in DEA matters. The government will structure settlements to maximize their benefit, not yours. What looks like a compromise often locks you into restrictions that effectively end your practice.
Watch especially for these terms: mandatory exclusion from certain patient populations, required prior approval for controlled substance prescriptions, mandatory auditing at your expense, surrender of the registration as part of the settlement, or prohibitions on reapplying for specified periods.
What Spodek Law Group Does Differently
Most healthcare providers only think about DEA issues when the Order to Show Cause arrives. At that point, the DEA has already investigated for months or years. They've built their case. Your playing catch-up from day one.
Todd Spodek and the team at Spodek Law Group understand that the best DEA defense starts long before an Order to Show Cause - with proper compliance systems, regular audits, and understanding exactly what the DEA looks for. But when that envelope arrives, we also understand how to fight effectively.
We've handled hundreds of federal administrative matters. We know the hearing process inside and out. We know which arguments work and which don't. We know when to fight for every inch and when strategic settlement serves the clients interests better then prolonged litigation.
Most importantly, we understand the psychology of this moment. Your terrified. Your second-guessing everything. Your probly wondering whether you even want to fight. We've seen that paralysis destroy careers. We wont let it destroy yours.
The clock started the moment you opened that envelope. Call us at 212-300-5196. This conversation costs nothing. Waiting costs everything.
The Corrective Action Plan Option
Heres something most providers dont know exists. When you recieve an Order to Show Cause, you have the opportunity to submit a corrective action plan. This is seperate from requesting a hearing - its an attempt to convince the DEA that you've identified the problems and are fixing them.
The DEA reviews the corrective action plan and decides whether to discontinue proceedings, defer action while you implement corrections, or require modifications to your plan before accepting it. If they accept the plan, you might avoid revocation entirely.
But heres were this gets tricky. A corrective action plan is basicly an admission that problems existed. Your documenting what went wrong and how your fixing it. This creates a record that the DEA can use against you later if you dont follow through perfectly, or if they decide your corrections werent sufficient.
The decision whether to submit a corrective action plan - and what to include in it - is one of the most consequential strategic choices in the entire process. Get it wrong and you've made the government's case for them. Get it right and you might resolve everything without a hearing.
This is not something to attempt without specialized counsel.
The Federal Court Appeal Path
If the DEA Administrator's final order goes against you, your not done. You can appeal to the United States Court of Appeals - either the D.C. Circuit or the circuit where you maintain your principal place of business. You have 30 days from notice of the decision.
Federal court review of agency decisions operates under the Administrative Procedure Act. The court looks at whether the decision was arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with law. They also check for constitutional violations, statutory interpretation errors, and procedural failures.
This sounds technical. It is. But heres what matters: the court gives considerable deference to the agency's factual findings. They're not relitigating your case from scratch. They're asking whether the DEA followed proper procedures and reached a reasonable conclusion based on the record.
Appeals can succeed. The Administrator sometimes overreaches. Procedural errors happen. Constitutional arguments matter. But the success rate is lower then you'd hope, and the timeline adds another year or more to an already agonizing process.
Still, sometimes appeal is the only path forward. And sometimes the threat of appeal creates settlement leverage that didnt exist before the Administrator ruled.
The Hard Truth About DEA Actions
I'll be honest with you about something most attorneys wont say: the DEA dosent lose many of these cases. The burden of proof is on them, but its a preponderance standard, and by the time they issue an Order to Show Cause, theyve already decided they can meet it. They dont bring weak cases.
But "usually wins" isnt "always wins." And even in cases were the outcome looks inevitable, HOW you lose matters for what comes next. A negotiated resolution preserves options that default or immediate surrender destroys. A fought case sometimes reveals DEA weaknesses that change the trajectory entirely. An appeal can reverse an Administrator's overreach.
The 2023 Operation "Hypocritical Oath" showed how aggressive the DEA can be - criminal charges, search warrants, and administrative license revocations all at once. One physician in that operation had written "holy trinity" prescriptions - a narcotic, tranquilizer, and muscle relaxant together. A patient died. The case was devastating.
But not every DEA action involves patient deaths or obvious wrongdoing. Sometimes its record-keeping mistakes. Sometimes its prescribing patterns that look suspicious to an algorithm but make medical sense to anyone who understands your patient population. Sometimes its circumstancial evidence that doesnt tell the whole story.
You deserve the chance to tell your story. The DEA will tell theirs. Make sure someone is fighting to tell yours.
More importantly, you deserve to understand whats actually happening to you. Not the sanitized version. Not the hopeful fiction. The reality - including the hard parts.
Because understanding the reality is the first step toward surviving it.
The next step is calling 212-300-5196.
