California DEA Investigation Lawyer

California DEA Investigation Lawyer: The Death Certificate Project and CURES Database Prosecution Pipeline

California runs something called the Death Certificate Project. Here’s how it works: when anyone dies of a drug overdose or intoxication, the Medical Board of California and the Department of Public Health automatically identify every prescriber who wrote that person a controlled substance prescription in the three years before death. Not just the prescriber whose drugs caused the death. Everyone who prescribed any controlled substance to that patient in the preceding three years.

Between 2016 and 2017, the Attorney General filed 314 accusations against physicians and surgeons. According to the Medical Board’s own documentation, 150 of those accusations – nearly half – originated from the Death Certificate Project. That’s 150 investigations triggered not because someone filed a complaint, not because a pharmacy raised concerns, but because an algorithm identified prescribers associated with patients who subsequently died.

The CURES database – California’s Controlled Substance Utilization Review and Evaluation System – makes this possible. Participation is mandatory for every prescriber and dispenser with a DEA registration. The system collects data on every controlled substance prescription in California. And under state law, this information is available to law enforcement, regulatory boards, and state agencies for disciplinary, civil, or criminal purposes. Your prescribing history isn’t just documented – it’s actively analyzed for prosecution potential.

The Death Certificate Project

Heres the uncomfortable reality about prescribing controlled substances in California. If you prescribe opioids to a patient who later dies of an overdose – even if they die from illicit fentanyl you never prescribed, even if they die three years after your last prescription, even if your medication had nothing to do with there death – you may be investigated by the Medical Board.

The Death Certificate Project doesnt distinguish between prescribers whose medications contributed to death and prescribers who simply had the patient in there practice at some point. The system casts a wide net. Every prescriber who touched that patient’s controlled substance history in the preceding three years gets flagged for potential review.

Think about what that means for your practice. Patient dies of illicit drug overdose in 2025. You prescribed them tramadol for post-surgical pain in 2023. The Death Certificate Project identifies you as a prescriber to the deceased. Your prescribing history gets reviewed. Maybe nothing happens. Maybe you get an accusation. The 150 accusations from this project in a single two-year period demonstrate that somethings happening to someone.

The project is a joint initiative between the Medical Board and the Department of Public Health. Its designed to identify problematic prescribing patterns that might be contributing to overdose deaths. But the mechanism – automatic review of all prescribers to deceased patients – creates investigation exposure for practitioners whose prescribing may have been entirely appropriate.

8,201 Prescriptions in One Year

Dr. Siao operated a family medicine practice in San Jose. Federal investigators first identified him through a separate prescription fraud investigation. When they reviewed the CURES database, they discovered that Siao had written 8,201 prescriptions for controlled substances in just one year – from May 2016 to May 2017.

Thats roughly 22 prescriptions per day, every day, for a year. The math alone raises questions about wheather meaningful medical evaluation could accompany each prescription.

But heres were Siao’s case becomes a warning about ignoring obvious signals. He continued prescribing opioids to one patient after she repeatedly claimed her pills had been lost or stolen. He recieved alerts from her insurer. He was advised that she had been jailed for selling pills. He kept prescribing to her anyway.

The patient who was jailed for selling pills – and Siao knew she’d been jailed for selling pills – continued to recieve prescriptions from him. That isnt an accidental oversight. That isnt a documentation failure. Thats prescribing to someone you know is diverting medication.

Siao was convicted on twelve counts of distributing opioids outside the usual course of professional practice. Each count carries a maximum sentence of 20 years. The prosecution also sought forfeiture of his medical license.

Prescriptions for Dead and Jailed Patients

Dr. Egisto Salerno practiced in San Diego. He pleaded guilty to opioid distribution after admitting that he signed prescriptions for patients who were deceased or incarcerated when the prescriptions were written. Dead patients. Patients in jail. Prescriptions with there names filled at pharmacies and the pills distributed.

Salerno admitted to signing prescriptions for 78,544 pills that lacked legitimate medical purpose. The plea agreements revealed the operation: paid “recruiters” brought patients – many of them homeless – to Salerno’s office to secure hydrocodone prescriptions. The pills were sold in San Diego and also smuggled into Mexico to be sold to a pharmacy there.

Seven other defendants were convicted alongside Salerno, including his medical assistants and the patient recruiters. The same pattern seen in Houston and Dallas and Fort Worth – homeless people recruited to create prescription opportunities – appeared in California.

Salerno was sentenced to 18 months. That might seem light for 78,544 pills, but he pleaded guilty and cooperated. The sentence reflects what cooperation can accomplish – and what it cant prevent. His medical career is over. His DEA registration is gone. Eighteen months is the prison time, but the consequences extend far beyond.

The Doctor in the Nail Salon

Dr. Edmund Kemprud was 78 years old when he was convicted. He worked in several locations around the East Bay and Central Valley. One of those locations was a back room of a nail salon and medi-spa in Tracy.

A back room. Of a nail salon. Where a licensed physician prescribed hydrocodone, alprazolam, and oxycodone.

Kemprud charged $79 per visit and saw at least 30 patients per day. At those numbers, he generated roughly $2,370 daily from controlled substance prescribing in the back of a nail salon. Trial testimony from undercover officers established that on 14 occasions he prescribed opioids without:

• Determining patients medical or prescription histories
• Conducting proper examinations
• Assessing risk of aberrant drug behavior

Heres the detail that demonstrates how his practice operated. Several pharmacies were so troubled by Kemprud’s prescriptions that they instituted policies to not fill them. The pharmacies – the entities that would profit from filling prescriptions – decided they couldnt fill what he was writing. And he continued practicing anyway.

The pharmacy refusals should have been a warning. They became evidence instead. When pharmacies refuse to fill your prescriptions, thats not just a business problem. Its a documented indication that neutral third parties have concluded something is wrong with your prescribing.

How CURES Data Flows to Prosecution

The CURES database serves multiple functions simultaneously. It helps prescribers identify patients who might be doctor shopping. It helps pharmacists identify concerning patterns before dispensing. And it provides investigators with complete prescribing histories when prosecution becomes a possibility.

Under California law, CURES information is available to:

• State, local, and federal public agencies
• Law enforcement
• Regulatory boards

This data can be used for disciplinary purposes – Medical Board accusations. For civil purposes – malpractice, negligence claims. For criminal purposes – federal prosecution.

The same database serves all three tracks. The information you enter when prescribing controlled substances feeds into a system that can be accessed for investigation from multiple directions. A patient complaint might trigger Board review that accesses CURES. A federal investigation might access CURES through law enforcement channels. A death might trigger the Death Certificate Project which automatically analyzes CURES data.

Theres no single pathway from CURES to prosecution – there are multiple pathways, and they can operate simultaneously.

Operation Hypocritical Oath

The DEA led an operation called “Hypocritical Oath” that resulted in the arrests of nine defendants, most of them medical professionals. The operation combined criminal charges with administrative actions – search warrants alongside DEA license revocations.

The name itself tells you how federal authorities view these prosecutions. “Hypocritical Oath” – a mockery of the Hippocratic Oath that physicians take. The branding suggests that prosecutors see these cases as fundamental betrayals of medical ethics, not just regulatory violations or even criminal distribution.

Operation Hypocritical Oath targeted what authorities called diversion of dangerous narcotics – primarily opioids – to the black market. The combination of criminal prosecution and license revocation demonstrates the coordinated enforcement approach. Even if criminal charges dont result in conviction, the administrative actions can end a prescribing career.

The operation focused on the Central District of California – Los Angeles and surrounding areas. But similar coordinated operations can occur anywhere in the state. The infrastructure exists. The database exists. The willingness to pursue medical professionals criminally while simultaneously pursuing them administratively exists.

Pain Management Specialties Face Higher Risk

The prosecution patterns have shifted over time. As family medicine practitioners reduced opioid prescribing in response to enforcement pressure, the relative risk increased for specialties that still treat patients with chronic pain. Pain management physicians, physical medicine and rehabilitation specialists, neurologists, and neurosurgeons now bear a disproportionate share of prosecution attention.

This makes sense from an enforcement perspective. If prescribing volume decreases in primary care but remains high in pain specialties, statistical outlier analysis will increasingly identify pain practitioners. The specialties that legitimately require opioid prescribing for there patient populations become the specialties most likely to trigger investigation.

The prosecution evolution also involves “more subtle charges” according to analysis of DEA patterns. The cases increasingly involve interpretation of medical purpose and standard of care – not just obvious pill mills, but disputes about wheather prescribing met professional standards. These cases are harder to defend because they require expert testimony about appropriate practice rather then clear-cut evidence of criminal intent.

What Actually Protects California Practitioners

If your prescribing controlled substances in California, you operate under a mandatory database system that feeds automatic investigation through the Death Certificate Project and provides evidence for criminal, civil, and disciplinary proceedings. 150 accusations originated from one automated project in two years. Pharmacies refusing to fill prescriptions didnt stop prosecution. A doctor prescribed from a nail salon back room. What actualy protects you?

First: Understanding that patient deaths trigger automatic prescriber review. If a patient dies of an overdose, your prescribing to them in the preceding three years will be examined. Documentation that establishes legitimate medical purpose isnt just good practice – its protection against investigation triggered by events you couldnt control.

Second: Taking pharmacy refusals seriously. When pharmacies refuse to fill your prescriptions, treat that as the warning it is. Kemprud had multiple pharmacies refuse his prescriptions. He kept prescribing. The refusals became evidence. Change your practices when neutral third parties signal concern.

Third: Responding to alerts about patient behavior. Siao was told his patient had been jailed for selling pills. He kept prescribing to her. That decision – continuing after explicit warning about diversion – transformed his case from overcounting prescriptions to conscious distribution to a known drug seller.

Fourth: Recognizing the multi-track nature of CURES access. The same data feeds disciplinary, civil, and criminal proceedings. An accusation from the Medical Board can coexist with a federal prosecution can coexist with civil litigation. Defense strategy has to account for all three tracks operating simultaneously.

Fifth: Immediate legal counsel upon any investigation contact. The Death Certificate Project may have already flagged you. CURES data has already documented your prescribing. When investigation contact comes, your entire controlled substance history is available to investigators. Explanations wont protect you. Legal strategy from the beginning is the only protection.

Thats the reality of prescribing controlled substances in California in 2025. The Death Certificate Project targets prescribers automatically when patients die. CURES documents everything and shares it everywhere. Pharmacies that refuse your prescriptions are documenting problems for future prosecution. And a 78-year-old doctor prescribed from a nail salon back room until federal prosecution ended his career. The database is watching. The question is wheather your prescribing can survive the scrutiny its already subject to.