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`po es
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`UNITED STATES DISTRICT COURT: > |
`MIDDLE DISTRICT OFFLORIDA = e
`3
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`TAMPA DIVISION
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`UNITED STATES OF AMERICA,
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`Plaintiff,
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`<
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`
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`v. Case No.¥:29-@V-OJ725-TPB- JSS
`FILED UNDER SEAL
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`chsSdAon
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`NATHANIEL ESALOMI,
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`Defendant.
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`/
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`COMPLAINT UNDER THE CONTROLLED SUBSTANCES ACT FOR
`INJUNCTIVE RELIEF AND CIVIL PENALTIES
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`INTRODUCTION
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`1.
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`The United States ofAmerica sues for injunctive reliefand civil
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`monetary penalties based on the defendant’s violations of the Controlled Substances
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`Act, 21 U.S.C. § 801, et seq. (the “CSA”) and its implementingregulations, 21
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`C.F.R. § 1301, et seq.
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`2.
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`Opioid abuseis a national public health emergency. The dispensing and
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`distributing of controlled substances, including prescription opioid painkillers,
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`without a legitimate medical purpose and outside the usual course of professional
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`practice, exacerbatesthis crisis and harmsthe public health.
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`3.
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`The defendant, Nathaniel Esalomi, has both fueled andprofited from
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`the opioid epidemic by repeatedly dispensing powerful opioids prone to abuse in
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`violation of the CSA through the guise of Apexx Pharmacy, which he ownsandruns
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`as the sole pharmacist. In transactions with undercover law enforcement, Esalomi
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`repeatedly filled prescriptions for controlled substances that he knew were not
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`legitimate in exchange for cash. Esalomi also repeatedly filled prescriptions in the
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`namesof dead patients and falsely recorded that these patients were present in the
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`pharmacy whenthe drugs were dispensed. In so doing, Esalomi violated the CSA.
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`4,
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`Accordingly, the United States seeks to enjoin defendant’s unlawful
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`conduct to protect the public health and imposecivil monetary penalties for past
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`violations of the CSA.
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`JURISDICTION AND VENUE
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`5.
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`This Court has jurisdiction over the subject matter and all parties to this
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`action pursuant to 21 U.S.C. §§ 842(c)(1)(A) and 882(a), 28 U.S.C. §§ 1331, 1345,
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`1355, and 1367(a).
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`6.
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`This Court has personaljurisdiction over the defendant, and venueis
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`properin this district pursuant to 28 U.S.C. §§ 1391(b) and 1391(c) because the
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`defendanteither resides in this district or transacts businessin this district.
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`PARTIES
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`The plaintiff is the United States of America.
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`The defendant, Nathaniel Esalomi, is licensed by the State of Florida as
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`7.
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`8.
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`a pharmacist. Atall times relevant to this Complaint, Esalomi owned and operated
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`Apexx Pharmacy, LLC (“Apexx”’), which does businessas a retail pharmacy,
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`located at 10343 State Road 52, Hudson,Florida 34669. Esalomiis the sole
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`pharmacist and the pharmacist-in-charge of Apexx.
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`2
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`LEGAL BACKGROUND
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`A.
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`Applicable statutes, regulations, and guidelines
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`9.
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`The CSA andits implementing regulations govern the manufacturing,
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`distributing, and dispensing of controlled substances in the United States. Congress
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`recognized the importanceofpreventing the diversion ofdrugs from legitimate
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`medical or scientific uses to any other illegitimate uses. The CSA establishes a closed
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`regulatory system under whichit is unlawful to manufacture, distribute, dispense, or
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`possess any controlled substance except in a manner authorized by the CSA. 21
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`U.S.C. §§ 841(a), 842(a).
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`10.
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`11.
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`The CSA categorizes controlled substancesin five schedules.
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`Schedule I consists of substances that have “a high potential for abuse,”
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`“no currently accepted medical use in treatment in the United States,” and “a lack of
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`accepted safety for use under medical supervision.” 21 U.S.C. § 812(b)(1); 21 C.F.R.
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`§ 1308.11.
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`12.
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`Schedule II contains drugs with “a high potential for abuse” that “may
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`lead to severe psychological or physical dependence” but nonetheless have “a
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`currently accepted medical use in treatment.” 21 U.S.C. § 812(b)(2).
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`13.
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`Schedule III contains drugs in which, although the abuse potential is
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`less than a Schedule II drug, such abuse maylead to moderate “physical dependence
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`or high psychological dependence.” Schedule III drugs also have “a currently
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`accepted medical use.” 21 U.S.C. § 812(b)(3).
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`14.
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`Schedule IV contains drugs that, although having a lower abuse
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`3
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`potential than Schedule III drugs, still may lead to a physical or psychological
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`dependence when abused. 21 U.S.C.§ 812(b)(4).
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`15.
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`Schedule V contains drugs that, although having a lower abuse
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`potential than Schedule IV drugs, still may lead to a physical or psychological
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`dependence when abused. 21 U.S.C. § 812(b)(5).
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`16.
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`As relevant here, the following substances are controlled substances
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`regulated under the CSA:
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`fo. Promethazine-Codeine (Schedule V);
`. Oxycodone (Schedule I);
`Hydromorphone (Schedule I]);
`. Suboxone (ScheduleIII).
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`Qaso
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`17.
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`The term “distribute” meansto deliver (other than by administering or
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`dispensing) a controlled substance ora listed chemical. The term “distributor” means
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`a person whoso delivers a controlled substance or a listed chemical. 21 U.S.C.
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`§ 802(11).
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`18.
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`The term “dispense” meansto deliver a controlled substance to an
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`ultimate user or research subject by, or pursuant to the lawful orderof, a practitioner,
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`including the prescribing and administering of a controlled substance and the
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`packaging, labeling or compounding necessary to prepare the substance for such |
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`delivery. The term “dispenser” meansa practitioner whoso delivers a controlled
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`substance to an ultimate user or research subject. 21 U.S.C. § 802(10).
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`19.
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`The terms “deliver” or “delivery” mean the actual, constructive, or
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`attempted transfer of a controlled substance or a listed chemical, whether or not there
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`4
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`exists an agencyrelationship. 21 U.S.C. § 802(8).
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`20.
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`The CSA requires those who manufacture, distribute, or dispense
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`controlled substances to obtain a registration from the DEA. 21 U.S.C. § 822(a). A
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`registrant is permitted to dispense or distribute controlled substances only “to the
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`extent authorized by their registration and in conformity with the [CSA].” 21 U.S.C.
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`§ 822(b). A pharmacist need not be registered with DEA if the pharmacy which
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`employs the pharmacist is registered with DEA. 21 U.S.C. § 822(c)(1); see also 21
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`C.F.R. § 1306.06.
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`
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`21. Atall times relevant to this Complaint, Apexx wasregistered asaretail
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`pharmacy with DEAin Schedule IJV controlled substances underregistration
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`number FA54933363. This DEAregistration authorizes Apexx to “dispense”
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`controlled substances.
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`22.
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`Agents and employeesof a registered manufacturer, distributor, or
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`dispenser of controlled substances, such as a pharmacist employed bya registered
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`pharmacy,are not required to register with DEA,“if such agent or employeeis
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`acting in the usual course of his business or employment.” 21 U.S.C. § 822(c)(1).
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`23.
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`Under the CSA,the lawful dispensing of controlled substances is
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`governed by 28 U.S.C. § 829 and more specifically in Part 1306 ofthe CSA’s
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`implementing regulations. See generally 21 C.F.R. § 1306.
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`24.
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`Unless dispenseddirectly by a practitioner (other than a pharmacist) to
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`an ultimate user, no Schedule IT controlled substance may be dispensed without the
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`written prescription of a practitioner, such as a physician. 21 U.S.C. § 829(a). Unless
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`5
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`dispensed directly by a practitioner (other than a pharmacist) to an ultimate user, no
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`Schedule III or IV controlled substance may be dispensed without a written or oral
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`prescription from a practitioner. 21 U.S.C. § 829(b). No controlled substance in
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`schedule V .. . may be distributed or dispensed other than for a medical purpose. 21
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`U.S.C. § 829(c).
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`
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`25. Suchaprescription for a controlled substance may only be issued by an
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`individual who is (a) “authorized to prescribe controlled substances by the
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`jurisdiction in whichheis licensed to practice his profession” and (b) registered with
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`the DEA. 21 U.S.C. § 822; 21 C.F.R. § 1306.03.
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`26. A prescription for a controlled substanceis valid only if issued “for a
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`legitimate medical purpose by an individual practitioner acting in the usual course of
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`his professional practice.” 21 C.F.R. § 1306.04(a); United States v. Moore, 423 U.S.
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`122, 140-42 (1975); Ruan v. United States, 142 S. Ct. 2370, 2382 (2022) (explaining
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`that this is an objective standard).
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`27.
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`“An order purporting to be a prescription issued notin the usual course
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`of professional treatment. .
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`. is not a prescription within the meaning andintent”of
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`21 U.S.C. § 829 and “the person knowingly filling such a purported prescription, as
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`well as the personissuingit, shall be subject to the penalties provided for violations
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`of the provisions of law relating to controlled substances.” Jd.
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`28.
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`“The responsibility for the proper prescribing and dispensing of
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`controlled substances is upon the prescribing practitioner, but a corresponding
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`responsibility rests with the pharmacist whofills the prescription.” 21 C.F.R
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`6
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`§ 1306.04(a). Thus, a pharmacist may notfill a controlled substance prescription
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`unless it has been issued for a legitimate medical purpose.
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`29. Moreover, “[a] prescription for a controlled substance may only be
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`filled by a pharmacist, acting in the usual course of his professional practice and
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`either registered individually, or employed in a registered pharmacy ...” 21 C.F.R.
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`§ 1306.06.
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`30.
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`Under the CSA “Tt shall be unlawful for any person .
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`.
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`. who is subject
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`to the requirements ofpart C to distribute or dispense a controlled substance in
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`violation of section 829 ofthis title.” 21 U.S.C. § 842(a)(1). Civil penalties may be
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`imposed for the violation of this provision.
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`31.
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`Additionally, the CSA prohibits maintaining a drug-involved premises.
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`This means (1) knowingly opening,leasing, renting, using, or maintaining any place
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`for the purposeofdistributing a controlled substance or (2) managing or controlling
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`any place and knowingly making that place available for use for the purpose of
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`unlawfully distributing a controlled substance. 21 U.S.C. § 856.
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`32.
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`Florida law defines the “Practice of the profession of pharmacy” to
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`include “compounding, dispensing, and consulting concerning contents, therapeutic
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`values, and uses of any medicinal drug; consulting concerning therapeutic values and
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`interactions of patent or proprietary preparations, whether pursuant to prescriptions
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`or in the absence andentirely independentof such prescriptions or orders; and
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`conducting other pharmaceutical services.” Section 465.003(1), Florida Statutes.
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`33.
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`Federal law authorizes only a pharmacist acting in the usual course of
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`7
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`professional pharmacypracticeto fill a controlled substance prescription. See 21
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`C.F.R § 1306.06. Under Florida Law,only a “pharmacist, in good faith and in the
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`course of professional practice only, may dispense controlled substances ... .”
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`893.04(1)(a). A pharmacy must keep recordsofthe individual pharmacist
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`responsible for dispensing of each prescription. See Fla. Admin. Code 64B16-
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`28.140(3)(b)(7).
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`34.
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`Florida law requires, as a condition of obtaining a pharmacy permit,
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`that the pharmacy designate a licensed pharmacist as a “prescription department
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`manager.” See Section 465.018(2), Florida Statutes. A Prescription Department
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`Manager, whichis also commonly referred to as a pharmacist in charge, must be
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`identified to the Florida Board of Pharmacy, and no pharmacist may serve as a
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`prescription department manager at more than one pharmacy. Section
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`465.022(11)(c), Florida Statutes. The prescription department manageris
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`“responsible for ensuring [.
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`.
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`.] compliance with all statutes and rules governing the
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`practice of the profession of pharmacy,including maintenanceofall drug records
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`and ensuring the security of the prescription department, and shall competently and
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`diligently exercise their responsibilities as a prescription department manager.” Fla.
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`Admin. Code. 64B16-27-450(2).
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`35.
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`Florida pharmacy law requires that a pharmacist maintain a patient
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`record system forall patients which “shall provide for the immediate retrieval of
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`information necessary for the dispensing pharmacist to identify previously dispensed
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`drugs at the time a new orrefill prescription is presented for dispensing.” Fla.
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`8
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`Admin. Code 64B16-27.800. Moreover, the pharmacist must “ensure that a
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`reasonable effort is made to obtain, record and maintain”patient information
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`relevant to pharmacypractice including, “Pharmacist comments relevant to the
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`individual’s drug therapy, including any other information peculiar to the specific
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`patient or drug.” Jd.
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`36.
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`Under Florida law,the practice of pharmacy requires that a licensed
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`pharmacist conduct a prospective drug utilization review prior to dispensing each
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`new andrefill prescription. Fla Admin. Code 64B16-27.810. A pharmacist must
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`review the patient pharmacy record to promote therapeutic appropriateness and
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`identify: (a) Over-utilization or under-utilization; (b) Therapeutic duplication;(c)
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`Drug-disease contraindications; (d) Drug-druginteractions; (e) Incorrect drug dosage
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`or duration of drug treatment; (f) Drug-allergy interactions; (g) Clinical
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`abuse/misuse. A licensed pharmacist must, upon recognizing any of these
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`indications, take appropriate steps to avoid or resolve the potential problems,
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`including consulting with the prescriber,if necessary. Id.
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`37.
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`The knowing dispensing of controlled substances when deliberately
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`ignoring warning signals that a prescription was not issued for a legitimate purpose
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`by a practitioner acting in the usual course of professional practice violates the
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`prescription requirement contained in 21 U.S.C. § 829, because doing so violates the
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`pharmacist’s corresponding responsibility to ensure that a prescription was issued by
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`a practitioner acting in the usual course of medical practice and for a legitimate
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`medical purpose (21 C.F.R. § 1306.04) and becausethe a controlled substance
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`9
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`prescription may only be filled in the usual course of professional pharmacy practice
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`(21 C.F.R. § 1306.06).
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`38.
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`Florida law also states that a pharmacist may not dispense a controlled
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`substance listed in Schedule IT, Schedule III, or Schedule IV to any patient without
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`first determining, in the exercise of her or his professional judgment, that the
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`prescription is valid. See Section 893.04(2)(a), Florida Statutes. The pharmacist may
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`dispense the controlled substance when the pharmacist or pharmacist’s agent has
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`obtained satisfactory patient information from the patient or the patient’s agent. Id.
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`Florida law requires that pharmacists interpret and act on clinical data, and perform
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`therapeutic interventions when necessary. Section 465.016(t), Florida Statutes.
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`39.
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`Pharmacists are therefore permitted to dispense a controlled substance
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`only in accordance with a generally accepted, objective standard of practice(i.e.,
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`“the usual course of his professional practice” of pharmacy) and only when a
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`prescription is issued for a legitimate medical purpose.Jd.
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`40.
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`Consequently, a pharmacist violates the CSA byfilling a prescription if
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`he or she knowsor was willfully blind to the fact that the prescription was not written
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`for a legitimate medical purpose. See 21 C.F.R. §§ 1306.04, 1306.06.
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`41.
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`A pharmacist must exercise sound professional judgment in
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`determining the legitimacy of a controlled substance prescription. Fla. Admin. Code
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`§ 64B16-27.831. “[W]hen a pharmacist is presented with a prescription for a
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`controlled substance, the pharmacist shall attempt to determinethe validity of the
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`prescription and shall attempt to resolve any concerns aboutthe validity of the
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`prescription by exercising his or her independent professional judgment.” Fla
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`Admin. Code § 64B16-27.831(2). Florida law requires all pharmacists to complete
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`continuing education on detecting illegitimate prescriptions. Fla. Admin. Code
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`§ 64B16-27.831(6).
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`42.
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`Under 21 U.S.C. § 842(a)(1) it is “unlawful for any person whois
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`subject to the requirements of Part C” of the CSA “to distribute or dispense a
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`controlled substance in violation of {21 U.S.C. § 829].” Thus, a pharmacist whofills
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`a prescription in violation of 21 U.S.C. § 829 and 21 C.F.R. § 1306 subjects the
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`pharmacy who employs him orherto civil penalties under 21 U.S.C. § 842(a)(1).
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`B.
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`Penalties and other remedies
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`43.
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`The penalty for a person who violates 21 U.S.C. § 842(a)(1) is as much
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`as $67,627 for each violation. See 21 U.S.C. § 842(c)(1)(A); 28 C.F.R. § 85.5, Federal
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`Register Vol. 86, No. 236.
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`44.
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`Under 21 U.S.C. § 856(d), the civil penalty for a person whoviolates 21
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`U.S.C. § 856(a) is no more than the greater of (1) $379,193 or (2) two times the gross
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`receipts, either known or estimated, that were derived from each violation thatis
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`attributable to the person. 28 C.F.R. § 85.5, Federal Register Vol. 86, No. 236.
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`45.
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`The CSA authorizes federal courts to enjoin violations of the CSA,
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`including violations of Sections 842(a)(1) and 856. See 21 U.S.C. §§ 843(f) and
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`882(a).
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`FACTUAL ALLEGATIONS
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`46.
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`On May11, 2022, law enforcementreceived a report of potentially
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`11
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`fraudulent prescriptions for promethazine with codeine cough syrup (“‘promethazine-
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`codeine”) being filled at pharmacies in Pinellas, Pasco, and Hillsborough Counties.
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`The individual filling the prescriptions was a known drugtrafficker and the
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`purported prescriptions were issued by a Tampa area physician, “Doctor 1.”
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`47.
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`Oxycodoneis a potent opioid in Schedule II and the 30 mg formulation
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`is the highest strength formulation of immediate-release oxycodone,is often diverted,
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`and hasa significant street value.
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`48.
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`Promethazine-codeine is a Schedule V controlled substance. When
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`prescribed legitimately, the drug is used as an acute cough suppressant. Codeine is an
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`opioid. However, promethazine-codeine is commonly diverted and abused, andis
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`often an item stolen in pharmacy robberies. Whenused recreationally,it is often
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`mixed with beverages or other drugs. Onebottle of promethazine-codeine, which
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`costs relatively little to purchase through a pharmacy,! commandsseveral thousand
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`dollars when sold illicitly on thestreet.
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`49.
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`Suboxoneis an opioid and a controlled substance in schedule III andis
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`approved to treat the symptomsof opioid withdrawal. Suboxoneis, however, prone
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`to abuse andhasa retail street value.
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`50.
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`In June, 2022, law enforcement was alerted that Doctor 1 writes
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`prescriptions in exchange for cash, charging $450 for an oxycodoneprescription and
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`1 See https://www.goodrx.com/promethazine-codeine?form=syrup&dosage=6.25mg-10mg-
`Sml&quantity=470&label_override=promethazine-codeine.
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`12
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`$650 for a promethazine-codeine prescription. Doctor 1 issues purported
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`prescriptions based on the information provided on a driver’s license but without
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`seeing or having a doctor-patient relationship with the person depictedin thelicense.
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`51.
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`Subsequently, in two transactions conducted by law enforcement,
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`Doctor 1 wrote more than a dozen prescriptions for controlled substancesto
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`individuals Doctor 1 had never met or examined, based on nothing more than text
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`message containing imagesof the purported patients’ driver’s licenses. Doctor 1
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`provided these prescriptions in exchange for thousandsofdollars in cash.
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`52.
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`On July 7, 2022, two undercoverlaw enforcementofficers took six of
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`these prescriptions to Apexx to be filled by Esalomi.
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`53.
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`The six prescriptions were for identical quantities of oxycodone 30 mg
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`tablets, promethazine-codeine, and suboxonefor each of the two undercover law
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`enforcementofficers presenting the prescriptions.
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`54.
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` Esalomifilled these six prescriptions despite having actual knowledge
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`or being willfully blind to the fact that they were not legitimate. Esalomi attempted
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`to concealthe illegitimate nature of the prescriptions by creating four non-controlled
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`substance prescriptions, which no doctor had issued, for each undercover law
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`enforcementofficer.
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`55.
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`Toconceal the illegitimate prescriptions amongprescriptions for
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`medications subject to less law enforcement scrutiny, Esalomi fraudulently created
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`four additional prescriptions for the non-controlled substances azithromycin,
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`docusate sodium (stool softener), cyclobenzaprine (muscle relaxant) and ibuprofen
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`13
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`for each undercover law enforcementofficer. No doctor issued these prescriptions,
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`nor did the undercover law enforcementofficers request them. However, Esalomi
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`added these to each orderas if they were prescriptions issued by Doctor1.
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`56.
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`The exceedingly high price that Esalomi charged for the prescriptions
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`also demonstrates his knowledge that they were not legitimate. Esalomi charged
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`$650 for each of the two 473 ml bottles of promethazine-codeine, whichis far above
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`the marketprice for this medication when dispensed pursuantto a legitimate medical
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`purpose. A person would only be willing to pay these prices because the
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`promethazine-codeine wasnot intendedfor legitimate medical use, such as having
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`an expectation to ultimately sell the controlled substances on the street for a much
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`higherprice.
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`57,
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`Two different undercover law enforcementofficers conducted a second
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`visit to Apexx later in the day on July 7, 2022, seekingto fill other prescriptions
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`written by Doctor1.
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`58.
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`These prescriptions were for two of the same drugsas the prescriptions
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`filled duringthefirst visit: oxycodone 30 mg tablets and promethazine-codeine.
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`59.
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`Esalomifilled these prescriptions despite having actual knowledge or
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`being willfully blind to the fact that they were not legitimate. When oneofthe
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`undercoverofficers, Special Agent Joseph Pelz (“SA Pelz”), provided a driver’s
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`license from Massachusetts, Esalomi requested a Florida address. In the presence of
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`Esalomi, SA Pelz turned to the other undercover officer, Task Force Officer Jason
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`Gates (“TFO Gates”), and asked if he could use the same address shown on TFO
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`14
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`Gates’s undercoverdriver’s license. Then, while at the pharmacy counterin front of
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`Esalomi, SA Pelz filled out a patient form using TFO Gates’s undercoverdriver’s
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`license address. Esalomi knew that this was a ruse, and stated “because of out-of-
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`state I will have problems.”
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`60.
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`Esalomi’s request for SA Pelzto alter his address was designed to evade
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`law enforcementdetection. Controlled substance prescriptionsfilled in Florida are
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`required to be reported to the Florida Electronic Online Reporting of Controlled
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`Substances Evaluation, E-FORCSE, a prescription drug monitoring program
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`(“PDMP”). Out of state addresses or customers whotravel long distances to obtain
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`controlled substance prescriptions are well-knownredflags that a prescription may
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`not be legitimate. PDMP records can be reviewed by law enforcement and Esalomi
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`knew that a PDMPreport showingthat he hadfilled commonly diverted, high-
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`potency opioid prescriptions to an out-of-state customer mightattract law
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`enforcementscrutiny if discovered.
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`61. Onthe secondvisit to Apexx conducted by law enforcement, Esalomi
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`again fraudulently created additional prescriptions for the non-controlled substances
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`azithromycin, docusate sodium (stool softener), cyclobenzaprine (muscle relaxant)
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`and ibuprofen for each undercover law enforcementofficer. No doctor issued these
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`prescriptions, nor did the undercover law enforcementofficers request them.
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`However, Esalomi added these prescriptions to each orderas if they were issued by
`Doctor 1.
`|
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`62.
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`Esalomi again charged the excessive price of $650 for each of the two
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`15
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`473 ml bottles of promethazine-codeine. Esalomi charged this amount because he
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`knewthe controlled substance prescriptions wereillegitimate and that a person
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`paying these higher prices was willing to do so because the promethazine-codeine
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`wasnot intendedfor legitimate medical use, such as having an expectation to
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`ultimately sell the controlled substances on the street for a much higherprice.
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`63. Moreover, when TFO Gates removed a stack of cash from his pocket
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`and informed Esalomi he only had $1,650 rather than the total charge of $1,816 for
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`the four prescriptions and the four non-controlled medications, Esalomi accepted the
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`$1,650, stating “when you come back next time you pay me...can J trust you.”
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`64. A week later on July 14, 2022, SA Pelz and TFO Gates returned to
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`Apexx, and paid Esalomi$180 for the prior transaction, which Esalomiaccepted.
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`SA Pelz and TFO Gates then gave Esalomi eight prescriptions written by Doctor 1 -
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`four for promethazine-codeine and four for oxycodone — issued to patients who were
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`not present in the pharmacy. Noneofthese prescriptions were for SA Pelz’s or TFO
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`Gates’s undercoveridentities. Esalomi agreedto fill the prescriptions, so SA Pelz
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`then gave Esalomifour driver’s licenses corresponding with the identities of the
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`prescriptions. Esalomi instructed SA Pelz to fill out patient forms for the
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`prescriptions. Esalomi instructed SA Pelz to forge the signature for each of the four
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`purported patients on the forms.
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`65.
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`SA Pelz and TFO Gates left Apexx and returnedlater that day to pick
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`up the prescriptions. Esalomi informed them that because the patients did not have a
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`history offilling prescriptions for controlled substances in the Florida prescription
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`16
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`data monitoring program (PDMP), Esalomi would needto see the patients in the
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`pharmacy. SA Pelz and TFO Gatesstated that they would return the next day with
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`the patients.
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`66.
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`On July 15, SA Pelz and TFO Gates returned to Apexx with additional
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`undercoverofficers associated with the undercoverdrivers’ licenses that had been
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`provided to Esalomi the previous day. Each undercoverofficer filled out a new
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`patient form. Addressing the group, Esalomi stated that the undercoverofficer with a
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`Miamiaddress needed use a local address, because “Miamiis just too far for me.” In
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`the presence of Esalomi, TFO Gatestold the undercoverofficer with the Miami
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`address to just use the address on TFO Gates’s undercoverlicense. Esalomi
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`approvedthis change.
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`67.
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`Esalomi also stated that he needed telephone numbers from everyone
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`and indicated that it would be acceptable for everyone in the group to use TFO
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`Gates’s phone number.
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`68.
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`The group of undercoverofficers left the pharmacy, and SA Pelz and
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`TFO Gates returned approximately one hourlater, without the other undercover
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`officers. Esalomi told SA Pelz that the prescriptions would cost $3,632. SA Pelz paid
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`Esalomi $3,640, and Esalomi then provided two bags to TFO Gates.
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`69.
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`The bags contained four bottles of oxycodonepills, four 473 ml bottles
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`of promethazine-codeine, and four bottles of each of the non-controlled substance
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`medications. Again, Esalomi had fraudulently created prescriptions for these
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`medications as though they had been prescribed by Doctor 1, even though they were
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`17
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`
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`not, and had not been requested.
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`70.
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`As with the other transactions, Esalomi knew that the prescriptions
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`filled on July 15, 2022 were not legitimate. Esalomi requested the alteration of the
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`Miami address to avoid detection by law enforcement through the PDMPbecause a
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`person traveling a long distancetofill a prescription is a well-known redflag that a
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`prescription may notbe legitimate. Esalomi knew that a PDMP report showing he
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`hadfilled commonly diverted, high-potency opioid prescriptions to a south Florida
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`customer would attract law enforcementscrutiny if discovered.
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`71.
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`Likewise, Esalomi added the non-controlled substance prescriptions to
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`conceal the illegitimate controlled substance prescriptions amongprescriptions for
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`medications subject to less law enforcementscrutiny.
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`72.
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`Falsely adding non-controlled medications for customers who wish to
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`fill only controlled substance prescriptions also allowed Esalomi to maintain a false
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`ratio of controlled to non-controlled substances, which is a metric that is often
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`examined by pharmacydistributors.
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`73.|Esalomi charged the excessive price of $650 for each of the four 473 ml
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`bottles of promethazine-codeine, which is far above the marketprice for this
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`medication when dispensed pursuantto a legitimate medical purpose. Esalomi
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`charged this amount because he knew the controlled substance prescriptions were
`
`illegitimate and that a person paying these higher prices was willing to do so because
`
`the promethazine-codeine was not intended for legitimate medical use, such as
`
`having an expectation to ultimately sell the controlled substances on thestreet for a
`
`18
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`
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`muchhigherprice.
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`74.
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`The exchangesofillegitimate prescriptions for cash described in the
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`preceding paragraphswere essentially drug deals, in violation of 21 U.S.C.
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`§ 842(a)(1).
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`75.
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`In addition to the drug deals described above, Esalomi has separately
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`filled prescriptions for controlled substancesfor at least three patients (Patient 1,
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`Patient 2, and Patient 3) who were deceased at the time that the prescriptions were
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`filled, in violationof 21 U.S.C.§ 842(a)(1).
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`76.
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`Patient 1 died on June 21, 2019, but between July 19, 2021 and July 21,
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`2022, Esalomifilled at least twenty-three prescriptions for hydromorphone, twenty
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`prescriptions for oxycodone, two prescriptions for alprazolam, and oneprescription
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`for promethazine with codeine syrup for Patient 1. Each timehefilled the
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`prescriptions, Esalomifalsely indicated that Patient 1 came to the pharmacy in
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`person.
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`77.
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`Patient 2 died on June 16, 2021, but Esalomifilled prescriptions for
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`hydromorphonefor Patient 2 on July 29, 2021 and October 8, 2021. Each time he
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`filled the prescriptions, Esalomi falsely indicated that Patient 2 came to the
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`pharmacy in person.
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`78.
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`Patient 3 died on October 19, 2018, but Esalomifilled at least twenty
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`prescriptions for hydromorphone, thirteen prescriptions for oxycodone, and one
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`prescription for promethazine-codeine for Patient 3 between July 1,