Somewhere between charting patient notes and signing prescriptions, a file opened with your name on it. That was two years ago. The DEA's algorithm had already flagged your prescribing patterns, compared them against 150 risk factors, and marked you as a statistical outlier. You just found out yesterday.
The investigation has been running for 24 to 32 months. During that time, your PDMP data was pulled, your prescription history analyzed, your peers used as the baseline to judge you. Cooperating witnesses were cultivated - some of them people you trusted. By the time federal agents made contact, the case wasnt beginning. It was essentially built.
In the NBA healthcare fraud prosecution, 18 former players faced charges for defrauding the league's health plan of nearly $4 million. Spodek Law Group's client received time served - no additional prison time - while the scheme's ringleader got 10 years. The difference came down to understanding exactly how the investigation had worked before our client knew it existed. Thats what we do for physicians facing DEA investigations in Manhattan and Brooklyn.
The Investigation That Started Before You Knew
The DEA doesn't wait for complaints. They wait for algorithms. Every prescription you write flows into the Prescription Drug Monitoring Program - the PDMP - where automated systems compare your prescribing against every other doctor in your specialty. High Schedule II prescriptions? Flagged. Patients traveling unusual distances to see you? Flagged. Higher-than-average cash payments? Flagged. The algorithm runs continuously, scoring physicians without any human ever looking at the data.
There's 150 risk factors coded into their analytics system. Pain management specialists trigger most of them just by practicing their specialty. A dermatologist prescribing fewer opioids than you doesnt mean you're doing something wrong - it means you're treating a different patient population. But the algorithm cant distinguish between a pill mill and a pain management practice. It just sees the statistical deviation and opens a file.
Operation Profit Over Patients in July 2025 arrested 51 doctors across the country. Not one investigation started with a patient complaint. Every single case began with PDMP data showing prescribing patterns that deviated from statistical norms. The algorithm flagged them years before agents knocked on their doors. Fifty-one physicians who went to work every day, saw patients, wrote prescriptions - and had no idea a federal prosecution was being built around their practice.
Youre responding in days to years of preparation. The DEA spent 24 to 32 months collecting evidence, cultivating witnesses, running your financials. You have 48 hours to figure out whats happening. This asymmetry is the core problem. Theyre near the finish line. You just realized theres a race.
Your prescribing patterns have already been scored. Right now, as you read this, a risk assessment exists somewhere with your name attached. If that score crossed certain thresholds, surveillance may have already started. You wont know until agents arrive - and by then, the case is ready for prosecution.
So now you understand: the algorithm flagged you years ago, the investigation has been running for 24 months, and you just found out yesterday. That would be manageable if you only had one battle to fight. You don't.
Two Battles, Two Standards
When the DEA targets a physician, two investigations launch. Not one. Two separate tracks with different rules, different timelines, and different consequences. Most attorneys dont explain this because most attorneys only handle one or the other. We handle both.
The criminal investigation follows the rules you might expect. Beyond reasonable doubt. Constitutional protections. The right to a jury trial. The government has to prove you knowingly prescribed outside the bounds of legitimate medicine - and they have to prove it to twelve people who all agree. That takes time. Federal drug prosecutions can stretch two, three, even four years from indictment to trial.
The administrative investigation operates on a completely different standard: preponderance of evidence. More likely than not. Fifty-one percent. An administrative law judge can revoke your DEA registration - destroy your ability to prescribe controlled substances, end your career as you know it - based on evidence that wouldnt come close to supporting a criminal conviction. And the administrative track moves faster. Much faster.
Those same 51 doctors from Operation Profit Over Patients? They faced 93 administrative cases simultaneously. While the criminal prosecution was still in its early stages, the administrative track was already threatening their licenses. Some lost their DEA registrations before the criminal case even went to trial. Two tracks. Different rules. Same target.
The conviction rate in federal court runs between 92 and 97 percent. Those numbers apply to you. Federal court doesnt distinguish between street dealers and physicians - once you're in the system, you're facing a machine optimized for conviction. And the administrative track? That 51% standard makes it even easier to take your license.
Your license is at risk on something barely better than a coin flip. While you're preparing for a criminal defense that may take years, the administrative judge can end your prescribing authority in months. You need separate strategies for each track - and you need them now.
Two simultaneous investigations. Two different standards. Two paths to losing everything. And here's where most doctors make the critical mistake:
Why Every Instinct Fails You
The Instinct to Explain Backfires
Your first thought is to explain. Of course it is - you're not a drug dealer, you're a physician. If you could just make them understand your patient population, your treatment philosophy, the legitimate medical reasons behind every prescription, this would all go away. Thats what innocent people do. They explain.
Every word becomes evidence. The moment you start talking, you're creating a transcript. Prosecutors will read your explanation not to understand your perspective but to mine it for admissions. "So you knew patients were traveling long distances?" "You were aware of the cash payment patterns?" Your explanation becomes their cross-examination.
Your Documentation Becomes Their Evidence
You documented everything because thats what good doctors do. Every patient assessment. Every prescription rationale. Every follow-up note in the chart. Those records were supposed to protect you - proof that you were practicing legitimate medicine.
Heres what nobody told you: those same records are now the governments case. Count 1, Count 2, Count 3 - each one built from your own meticulous documentation. The EHR you used to protect yourself is the database they subpoenaed. Your thorough records dont prove your innocence. They provide the evidence for your prosecution.
Your Colleagues Started Talking Months Ago
While you were treating patients yesterday, unaware of any investigation, your business partner has been meeting with prosecutors for six months. The pharmacy tech who filled your prescriptions? Already provided testimony. That colleague you referred patients to? Being cultivated as a cooperating witness.
The testimony thats going to be used against you has been shaped and refined over months of meetings. Prosecutors have spent hours with these witnesses, asking questions, getting clarifications, preparing the narrative. You're responding to a story that's already been written - without your input, without your knowledge, without any opportunity to provide context.
The Cooperation Trap
But cooperation works, right? You've heard that cooperating leads to reduced sentences, that helping the government helps yourself. There's truth there - substantial assistance under the federal sentencing guidelines can lead to significant reductions.
Heres what cooperation actually requires: become a witness. Testify against your colleagues. Provide evidence about the pharmacies you worked with. Give up names the government doesnt have yet. If you're a solo practitioner with nothing to offer, your cooperation is worthless to them. And if they've already been building this case for 24 months - cultivating witnesses, subpoenaing records, preparing their prosecution - they probably don't need anything you have to give.
Cooperation can work. But only when strategically deployed AFTER your attorney has assessed what the government actually has, what they still need, and whether you have anything meaningful to offer. Cooperation as a first instinct, before that assessment, destroys cases that could have been won. We've seen it happen. One of those 51 doctors from Operation Profit surrendered his DEA license thinking it would satisfy the government. He's serving prison time anyway. Surrendering your license doesn't stop the criminal prosecution - they're separate tracks. The people who volunteer cooperation without strategic guidance don't get leniency. They just give away their leverage.
Youre 24 months behind your own prosecution, fighting two simultaneous battles, and every instinct you have about how to respond is wrong. The trap is closing. But theres a way out.
The Defense That Actually Works
Ruan v. United States reached the Supreme Court in 2022 after physicians kept getting convicted on a standard that didnt require proving intent. The government would show that prescribing patterns deviated from objective medical norms - what a hypothetical reasonable doctor would do - and that was enough. Fifteen ongoing prosecutions invoked the Ruan decision within three months of the ruling.
The shift was fundamental. Prosecutors can no longer just compare your patterns to peers and call deviation criminal. They have to prove what was going on inside your head. Subjective knowledge. Actual awareness that you werent treating legitimate patients. If you genuinely believed your prescriptions served legitimate medical purposes - even if that belief was wrong, even if other doctors would have done it differently - thats a defense under the Controlled Substances Act.
This changes everything about how we build your case. Your patient files, your treatment rationale, your clinical judgment - all of it becomes relevant to establishing what you actually believed. We can show that you operated with good faith, that you applied genuine medical judgment, that you had real treatment relationships with real patients even if your approach differed from peers.
But Ruan only works if raised correctly and early. We've seen attorneys who mention the case without knowing how to deploy it. They cite the Supreme Court opinion in motions without building the evidentiary foundation it requires. Ruan demands we establish your subjective state of mind through documentation, patient records, testimony about your clinical decision-making. It's not enough to invoke the case - you have to build the defense.
Spodek Law Group has defended physicians through DEA investigations in Manhattan and Brooklyn for years. We understand both tracks - criminal and administrative. We know how to challenge the algorithms assumptions, how to contextualize prescribing data, how to position your medical judgment as legitimate practice under Ruan. With a 10.0 Superb rating on Avvo and over 900 verified client reviews, we have the resources and experience these cases demand.
The investigation has been running for two years. You just found out. The administrative track is moving while the criminal case prepares. Every day of delay costs options - witnesses memories solidify around the prosecution's narrative, the administrative clock keeps ticking, and your window for strategic intervention shrinks.
Call Spodek Law Group at 212-300-5196. The next 48 hours matter more than the last 24 months.
