Former Doc Receives Prison Sentence for Telehealth Prescribing Scheme

March 06, 2024 - The United States Attorney’s Office for the Central District of California has sentenced a former physician to 37 months in federal prison for illegally prescribing medications, including opioid-based drugs, during telehealth sessions.

The physician, Raphael Tomas Malikian, owned and operated Happy Family Medicine, a clinic that offered telehealth services via telephone and text messages. He was a licensed physician authorized by the Drug Enforcement Administration (DEA) to prescribe medication.

According to the US Attorney’s office, Malikian issued prescriptions for controlled substances between December 2019 and August 2021 without getting the patient’s entire medical history, conducting a physical examination, requiring medical testing, or using diagnostic tools.

Further, Malikian did not verify individuals’ identities before prescribing controlled substances and allowed people to procure prescriptions in the names of others.

He also worked with two co-conspirators, who gave Malikian false names, addresses, and dates of birth. After he prescribed the controlled substance using this information, the co-conspirators filled and re-sold the medications on the black market, the US Attorney’s office stated. Many of the prescriptions included notes or documentation telling pharmacies not to verify the prescriptions as the medications were urgently required.

From April to July 2020, Malikian prescribed 702 pills with 10 milligrams of oxycodone and 240 milliliters of promethazine with codeine to an undercover law enforcement officer without a proper medical evaluation or verifying the person’s identity. He similarly did not conduct an evaluation or verification when he prescribed 234 pills of the painkiller Norco, which contained 2,340 milligrams of the opioid hydrocodone, and 180 pills of alprazolam (sold under the brand name Xanax), to another undercover law enforcement officer between May and June 2020.

The Medical Board of California suspended Malikian’s medical license in November 2021; a year later, it expired.

In October 2023, Malikian pleaded guilty to “one count of aiding and abetting the acquisition of a controlled substance by fraud and one count of distribution of oxycodone.” In addition to the prison sentence, Malikian has been ordered to pay a fine of $20,000.

“Considering the nature and circumstances of these offenses, there is no question that [Malikian’s] criminal conduct is serious and that the scope of [his] diversion scheme was expansive,” prosecutors said in a sentencing memorandum, according to a press release. “The amount of drugs that [Malikian] prescribed without any medical justification is substantial and contributed to this country’s opioid crisis.”

The sentencing comes on the heels of a year where the DEA’s regulatory flexibilities for virtual prescribing came under intense scrutiny.

Initially, the DEA proposed ending a pandemic-era exception that allowed healthcare providers to prescribe Schedule II controlled substances without a prior in-person examination. Schedule II drugs include codeine, fentanyl, hydrocodone, oxycodone, and methadone, a medication for opioid use disorder (OUD).

However, the healthcare industry pushed back, prompting the DEA to conduct listening sessions last September.

Most stakeholders at the listening sessions argued in favor of allowing virtual prescriptions of controlled substances without requiring an in-person exam beforehand.

“The ability for these providers to prescribe controlled substances and use their medical judgment over telemedicine without a prior in-person visit allows patients to receive clinically appropriate essential care via a convenient patient-centered modality,” said Helen Hughes, MD, medical director of the Office of Telemedicine at Johns Hopkins Medicine.

However, some stakeholders noted potential adverse impacts of eliminating the in-person exam requirement.

John Wells, MD, associate professor of clinical psychiatry at Louisiana State University Health Sciences Center, stated that telehealth prescribing has made it easier for people to gain access to benzodiazepines, opiates, narcotics, and other stimulants from remote prescribers who are not a part of their community.

Following the listening sessions, the DEA announced it would extend the flexibility until the end of 2024.