DEA Investigation of Nurse Practitioners

DEA Investigation of Nurse Practitioners: What You Need to Know in 2025

If your a nurse practitioner facing a DEA investigation, theres something you need to understand right now. Your not just risking your license – your risking your freedom. And unlike physicians, you have a second problem most NPs dont see coming: your collaborative practice agreement might destroy you. In 2024, Danielle Simonson got 70 months in federal prison. 70 months. For prescribing controlled substances to 54 patients. And heres what the DEA wont tell you – they dont care that your a “mid-level practitioner.” Under 21 USC 841, you face the exact same criminal exposure as any physician.

Look. Ive been defending nurse practitioners in DEA investigations for years, and the difference between those who keep there careers and those who lose everything comes down to understanding a few critical things. What your state practice authority actualy means. How your collaborative agreement can help or hurt you. What your rights are during an investigation. And why most NPs make fatal mistakes in teh first 48 hours after DEA contact.

Personally. Thats how liable you are. Not your supervising physician. Not your employer. You. Heres the thing most nurse practitioners dont understand until its too late – the law treats you exactly the same as a physician if you knowingly prescribe controlled substances outside the course of professional practice.

The Mid-Level Practitioner Myth – Why It Wont Protect You

Alot of nurse practitioners think their protected by their status as “mid-level practitioners.” I should mention – actualy, this is critical to understand – the law dont care about your professional title when it comes to criminal liability.

Heres the legal reality. Under 21 USC 841(a), it is unlawful for any person to knowingly or intentionally manufacture, distribute, dispense, or possess with intent to distribute a controlled substance. The statute makes absolutely no distinction between physicians, nurse practitioners, physician assistants, or any other prescriber category. None.

That means if you prescribe controlled substances outside the course of professional practice, you face the same criminal penalties as a physician who does the same thing. The same mandatory minimums. The same sentencing guidelines. The same prison time.

The Simonson Case (March 2024) makes this brutally clear:

Danielle Simonson, a nurse practitioner from Fort Ann, New York, received 70 months in federal prison. Her crime? Prescribing controlled substances to 54 patients from January 2020 through October 2022. Opioids like hydrocodone and oxycodone. Benzodiazepines. Stimulants. The court found she prescribed outside the course of professional practice and for no legitimate medical purpose.

70 months. Almost six years. For a nurse practitioner. There was no discount for being a “mid-level practitioner.” The sentencing guidelines treated her exactly the same as they would have treated a physician.

In fact, some courts have applied enhanced sentences when practitioners use their professional licenses to facilitate drug distribution. Your NP license isnt a shield – it can actually make your exposure worse.

State Practice Authority – The 50-State Trap

Why does state authority matter so much? Because your ability to prescribe controlled substances varies dramatically depending on where you practice. And if you get this wrong, your facing federal violations before you even realize theres a problem.

The American Association of Nurse Practitioners categorizes states into three divisions:

Full Practice Authority (22 states): NPs have prescriptive authority similar to physicians. You can prescribe controlled substances independently without physician oversight.

2) Reduced Authority (16 states): You need a collaborative practice agreement or joint practice agreement with a physician. The agreement must specifically authorize controlled substance prescribing.

Three: Restricted Authority (12 states): You need physician supervision or delegation for controlled substance prescribing. In some of these states, Schedule II prescribing is prohibited entirely for NPs.

Most states fall somewhere in the middle, but the specific requirements differ dramatically. Let me give you some examples that show just how different these rules can be:

Illinois: You need 45 graduate contact hours in pharmacology to prescribe Schedule II controlled substances. Without those hours? Your Schedule II prescriptions are unauthorized – even if you have a collaborative agreement.

Michigan: Maximum 30-day supply for Schedule II controlled substances. Write a 90-day prescription? Your in violation of state law, which creates federal exposure.

North Carolina: Your supervising physician must possess a DEA schedule equal to or greater than yours. If your supervising physician isnt registered for Schedule II and you are, theres a problem.

What happens if you cross state lines? If your licensed in a full practice state and prescribe to a patient in a restricted state, you may be prescribing without authorization. Each prescription becomes a potential federal charge. I know what your probably thinking – “I only practice in one state.” But telemedicine has created traps most NPs dont see coming.

Collaborative Practice Agreements – Your Sword and Shield

Real talk: if your in a reduced or restricted practice state, your collaborative practice agreement is both your greatest protection and potentially your biggest vulnerability. Usually this works to protect you… well, not always.

Heres what your collaborative agreement must include:

– Specific controlled substance authority – which schedules your authorized to prescribe
– Consultation requirements – when you must contact your supervising physician
– Documentation protocols – what records you must maintain
– Supervision frequency – how often chart reviews occur
– Emergency contact procedures – how to reach supervision when needed

Critical. Essential. Non-negotiable.

The agreement must be signed and in effect BEFORE you apply for your DEA registration. If you obtained your DEA registration without a valid collaborative agreement in place, you may have been prescribing without authorization from day one.

But heres where the agreement becomes a sword, not just a shield. When DEA investigates, your documented compliance with the collaborative agreement supports a good faith defense. “I followed my protocols. I consulted my supervising physician. I documented everything.” This evidence can make the difference between prison and freedom.

The opposite is also true. If your collaborative agreement says you must consult on complex controlled substance decisions and you never documented any consultations? That looks like you exceeded your scope. That looks like you knew you were operating outside your authority. That destroys a good faith defense.

The Dual Liability Trap – What Your Supervising Physician Faces

I know what your thinking – “My supervising physician will back me up.” Maybe. Maybe not. Ill come back to that, but first you need to understand the dynamic that most NPs dont see coming.

When DEA investigates a nurse practitioner, they also look at the supervising physician. The questions they ask:

– Did the supervising physician adequately supervise?
– Should the supervising physician have caught these red flags?
– Was the collaborative agreement jsut a piece of paper, or was there real oversight?
– Did the supervising physician enable the NP’s prescribing patterns?

This creates a problem you need to understand. Your supervising physician has their own license to protect. Their own DEA registration. Their own career. When the investigation gets intense, the supervising physician’s lawyer may advise them to distance themselves from you.

And heres the trap: in restricted states, you cant practice without supervision. If your supervising physician terminates the collaborative agreement – even before any formal action against you – you effectively lose your ability to work. Your income stops. Your leverage in negotiations evaporates. Your career may be over before the investigation even concludes.

Ive seen this happen. NP gets contacted by DEA. Tells supervising physician. Supervising physician panics. Collaborative agreement terminated. NP cant work, cant earn, cant afford adequate defense. Case resolved with devastating terms because NP had no negotiating position.

What should you do? Talk to a lawyer before you talk to your supervising physician. Understand your rights. Understand the dynamics. Dont walk into this blind.

Red Flags You Must Recognize and Document

Before we talk about what triggers investigations, you need to understand the red flags that DEA expects you to recognize. Most investigators say their looking for specific patterns that suggest diversion or illegitimate prescriptions. But heres the problem – theirs no official comprehensive list of red flags in DEA regulations. NPs are expected to recognize them from case law and enforcement precedent.

Why does this matter? Because you cant claim ignorance. If a red flag should have been recognized, the fact that you didnt know it was a red flag isnt a defense.

Patient-Related Red Flags:

– Cash payments (especially for expensive controlled substances)
– Long-distance travel to your practice
– Multiple pharmacy utilization (pharmacy shopping)
– Early refill requests
– Nervous demeanor or signs of intoxication
– Multiple patients from same address
– Young patients on high doses
– Patients who “lost” their prescriptions repeatedly

Prescription-Related Red Flags:

The most notorious is the “Holy Trinity” – opioid + benzodiazepine + muscle relaxant. This combination is so strongly associated with diversion that its almost always flagged. But their are others:

– Pattern prescribing (same drugs, quantities to multiple patients)
– Unusually large quantities for the indication
– High dosages without documented titration
– Multiple controlled substances on same date
– Prescriptions that dont match the diagnosis
– Rapid dose escalation without documentation

What you must do: When you identify a red flag, document how you resolved it. Who did you contact? What information did you obtain? Why did you proceed or refuse? The documentation is everything. “Verified” written on a chart is not enough – courts have specifically rejected this as insufficient.

What Triggers a DEA Investigation

Their building a case against you probly for months before you ever know about it. But understanding the triggers helps you understand where you might be vulnerable.

PDMP Red Flags – Every state has a Prescription Drug Monitoring Program. DEA analysts run algorithms looking for anomalies in your prescribing patterns. High volume. Pattern prescribing. Same medications to multiple patients. If your prescribing stands out, your on their radar. And heres something most NPs dont realize – PDMP data is shared across state lines now. If your prescribing to patients from multiple states, each of those state PDMPs may flag you independently.

Prescribing Volume – The 54-patient number keeps appearing in recent prosecutions. Simonson: 54 patients. Hansen: 54 prescriptions post-suspension. This appears to be a threshold where DOJ moves from observation to action. If you’ve prescribed controlled substances to 50+ patients with documentation gaps, your exposure is significantly elevated. I should also mention – its not just raw numbers. Its your numbers compared to other NPs in your specialty and region. If your writing significantly more controlled substance prescriptions then your peers, that anomaly gets flagged.

Whistleblowers – Staff members who recognize red flag patterns can file qui tam actions under the False Claims Act. Pharmacists who question your prescriptions can report to DEA directly. Other practitioners who see your patients can raise concerns. Billing staff who notice patterns in claims. The information comes from everywhere. And qui tam whistleblowers get a percentage of any recovery, which means theres financial incentive to report suspected fraud.

Supervising Physician Reports – In collaborative practice states, your supervising physician has obligations too. If they notice concerning patterns in chart reviews and fail to act, they face liability. Some supervising physicians, when they see concerning patterns, report to the board or DEA as a way to protect themselves. Your supervisor isnt always on your side.

Insurance Audits – Medicare and Medicaid fraud investigations frequently overlap with DEA investigations. What starts as a billing inquiry can quickly become a controlled substances case. If your billing patterns look unusual – too many E&M codes with controlled substance prescriptions, for example – the audit may trigger DEA involvement.

Operation Profit Over Patients (2025) – This is the one most NPs havent heard about. As part of the DOJ’s National Health Care Fraud Takedown, DEA executed a coordinated operation that resulted in:

– 51 arrests
– 122 criminal charges
– 93 administrative cases seeking registration revocation

But this wasnt random enforcement. The operation explicitly targeted nurse practitioners among other prescribers. DEA is now systematically going after mid-level practitioners. This is the new reality. If you thought NPs flew under the radar, that era is over.

The Ruan Defense Revolution – How It Helps Nurse Practitioners

Wait, this changes everything. In 2022, the Supreme Court decided Ruan v. United States. This wasnt just another case. It was a 9-0 decision that fundamentally altered how prescribers – including nurse practitioners – can be prosecuted.

I mentioned the 2022 decision earlier… actualy, its more accurate to call it the recent decision that changed everything for NP defense.

Before Ruan:

Prosecutors could convict based on an objective standard. They jsut had to show that a “reasonable practitioner” should have known the prescriptions were illegitimate. If your prescribing patterns looked bad, you could be convicted – even if you genuinely believed you were following proper procedure.

After Ruan:

Prosecutors must prove you actually knew the prescriptions were illegitimate. Not that you should have known. That you did know. This is the subjective intent standard, and the implications is massive for nurse practitioner defense.

Heres why this matters specifically for NPs:

1. Training limitations – If you were taught something was appropriate in your NP program, that supports good faith belief
2) Collaborative agreement protocols – If you followed your documented procedures, that supports good faith
Three: Supervision consultations – If you consulted with your supervising physician and documented it, that supports good faith

The Ruan decision has already been invoked in at least 15 ongoing prosecutions across 10 states. Defendants are citing it in post-conviction appeals, motions for acquittal, requests for new trials. Former Obama-era U.S. Attorney David Rivera said practitioners have a “great chance” of overturning convictions if they were prohibited from arguing good faith defense.

Using Your Supervising Physician’s DEA Number – The Federal Crime Most NPs Dont Know About

This is huge. And its something most lawyers agree… well, actually everyone agrees on this one. Using your supervising physician’s DEA number to prescribe controlled substances is a federal crime. Seperately from whether the prescriptions were medically appropriate.

Federal law explicitly requires that nurse practitioners obtain their own DEA registration to prescribe controlled substances. You cannot borrow, share, or use your supervising physician’s DEA number. Period.

But heres what happens in practice. Some NPs – particularly those new to practice – start prescribing wiht their supervising physician’s DEA number while waiting for their own registration to be approved. Or their employer tells them to use the physician’s number. Or they just dont know the law.

Every single prescription written using someone else’s DEA number is a potential federal charge. Not because the prescription was medically inappropriate – it might have been perfectly appropriate – but because you were not authorized to use that DEA number. This is a separate violation that gets added to any other charges.

What should you do? Get your own DEA registration before you prescribe any controlled substances. If your state requires a collaborative agreement first, get that signed. If your employer is pressuring you to prescribe before your registration is approved, refuse. Document that you refused. This pressure is common, but the liability falls on you.

Your Rights During a DEA Investigation

This is huge. Most nurse practitioners dont understand there rights during DEA investigations. Everyone agrees on the basics… well, most lawyers agree anyway. Lets break it down.

Right to Refuse to Answer Questions

You have the right to remain silent. When DEA agents show up at your practice or call you on the phone, you do not have to answer their questions. The correct response: “I appreciate you reaching out. On the advice of counsel, I need to consult with my attorney before discussing this matter.” Then stop talking.

Do not answer “just one more question.” Do not provide “context.” Do not try to explain. Every word you say can be used against you. The natural instinct to be helpful – to explain that your a good NP who was just trying to help patients – that instinct will destroy your defense.

Right to Counsel

Invoke this immediately. You have the absolute right to have an attorney present before answering any questions. DEA agents are trained to encourage you to talk before you get a lawyer involved. They may say things like “this will be easier if we just clear things up now” or “getting a lawyer will make this take longer.” Dont fall for it.

What Records Must Be Produced

If subpoenaed, you must produce certain required records. These include prescribing logs, patient charts, DEA order forms, inventory records. The Fifth Amendment does NOT protect these records – their required by law to be maintained, so they lose self-incrimination protection.

But you CAN challenge overbroad requests. You can challenge privileged materials. You can challenge undue burden. This is why you need counsel before responding to any subpoena – there are strategic decisions to make about scope and timing.

The Cooperation Trap – Why Talking Destroys Nurse Practitioners

Trust me on this. Actualy, let me explain why cooperation is so dangerous for NPs specifically.

Nurse practitioners are trained to be helpful. To communicate with patients. To explain medical decisions. To be transparent with regulators. These professional instincts – the same ones that make you a good clinician – will destroy you in an investigation.

DEA agents arent your friends. Their job is to build cases. Every question that seems innocent is designed to establish elements of liability. And for nurse practitioners, the questions are particularly dangerous because they can establish knowledge and intent.

Remember under Ruan, the government needs to prove you knew your prescriptions were illegitimate. When you explain “yes, I noticed that patient seemed unusual, but…” you just proved knowledge. When you say “I know most NPs dont prescribe this much, but I thought…” you just proved awareness of the standard. When you say “my supervising physician told me it was fine…” you just implicated your supervisor and created a paper trail DEA will follow.

The correct response to any DEA question:

“I appreciate you reaching out. On the advice of counsel, I need to consult with my attorney before discussing this matter. Please provide your contact information, and my attorney will be in touch.”

Then stop talking. No exceptions.

Investigation Stages – The Complete Timeline

For all intensive purposes, understanding the investigation timeline helps you understand when intervention is possible adn when its too late.

Stage 1: Pre-Investigation (Months 0-12)

DEA gathers prescribing data. Reviews PDMP records. Analyzes your patterns. Pulls your order history from distributors. Compares your prescribing to peers. No contact yet. You dont even know your being watched. This is why many NPs are shocked when the first contact comes – they had no warning. The investigation may have been active for a year before you knew anything.

Stage 2: Investigation Initiation (Months 12-16)

First contact. Could be an administrative subpoena for records. Could be a call from a DEA investigator. Could be agents showing up at your practice. This is when most nurse practitioners make there first fatal mistake – responding without counsel. The natural instinct to be helpful, to explain, to cooperate – these instincts will destroy you.

Stage 3-4: Record Review Phase (Months 16-24)

DEA brings in experts to review your prescribing records. Their calculating your “error rate.” Their building the narrative. This is where the critical decision gets made: administrative track or criminal track. Usually you can tell based on whether the U.S. Attorney’s office is involved… well, sometimes you cant tell until its too late.

Stage 5-6: Criminal Referral & Grand Jury (Months 20-28)

If your on the criminal track, the case goes to prosecutors. Grand jury subpoenas get issued. The investigation becomes formal criminal investigation. Your options narrow dramatically at this point.

Stage 7: Indictment (Months 26-32)

Grand jury votes. Your arrested or arrange voluntary surrender. Criminal prosecution begins. Defense costs explode.

State License Suspension – The Cascade Effect

Automatic. Unavoidable. Permanent consequences.

When your state nursing board takes action against you – even a temporary suspension – a cascade begins that most NPs dont understand until its too late. Actualy, let me explain exactly how this works.

The Hansen Case (June 2025) shows the pattern perfectly:

Scott Eric Hansen, a Seattle nurse practitioner, had his state license indefinitely suspended in 2024. The state board found his controlled substance prescribing “posed an immediate danger to public health and safety.” But Hansen made the catastrophic mistake: he kept prescribing after the suspension.

DEA investigation revealed he self-prescribed controlled substances at least 14 times AND wrote as many as 54 prescriptions for individuals after his state license was suspended. Result: DEA registration revoked. Career over. Potential criminal exposure for every prescription written post-suspension.

Heres the cascade most NPs dont see:

1. State board suspends or restricts license
2. DEA monitors state board actions – notification is automatic
3. Any prescribing after state action = unauthorized = criminal, not just administrative
4. The window between state suspension and DEA action is when most NPs make catastrophic mistakes
5. Criminal charges get added for post-suspension prescribing

The privilige of prescribing controlled substances comes from state authorization. The moment that authorization is suspended – even temporarily, even while under investigation – you must stop prescribing immediately. Not tomorrow. Immediately.

2024-2025 Enforcement Reality

Trust me when I tell you – DEA enforcement against nurse practitioners is at historic levels. This is something… wait, this is actualy the most important context for understanding your risk.

Danielle Simonson (March 2024) – 70 Months Federal Prison

Massive. Fort Ann, New York nurse practitioner. Prescribed controlled substances to 54 patients over approximately two years. Opioids, benzodiazepines, stimulants. Found to have prescribed outside course of professional practice. No legitimate medical purpose. The sentence was the same she would have received as a physician.

Joan Rubinger (January 2025) – Civil Injunction

DOJ sued this Stockton, California nurse practitioner for selling opioid prescriptions via Telegram. According to the complaint, she provided “price lists” to customers letting them select prescriptions from a menu: Oxycodone, Percocet, Xanax, Adderall. Cash transactions through encrypted messaging. The case shows DOJ specifically targeting telemedicine abuse.

Scott Eric Hansen (June 2025) – DEA Registration Revoked

Seattle ARNP. State license suspended for “immediate danger to public health.” Continued prescribing after suspension. Self-prescribed at least 14 times. Wrote 54 prescriptions post-suspension. Career ended.

Operation Profit Over Patients (2025)

51 arrests. 122 criminal charges. 93 administrative cases. Nurse practitioners specifically targeted. This wasnt random enforcement – this was coordinated, multi-district action specifically designed to target mid-level practitioners.

The Telegram/Telemedicine Trap

Ive seen NPs face catastrophic consequences for prescribing practices that seemed acceptable during COVID. The Rubinger case from January 2025 – well, recently, I should say – signals a major enforcement shift.

During the pandemic, telemedicine flexibilities exploded. DEA waived the in-person exam requirement for controlled substances. NPs built entire practices around remote prescribing. What was tolerated in 2021 is now prosecuted.

The Rubinger complaint reveals what DEA is looking for:

– Prescribing via encrypted messaging (Telegram, Signal)
– “Price lists” for medications
– Brief text conversations instead of clinical encounters
– Cash payments for prescriptions
– No physical examination
– No established patient relationship

Heres what the rules is now: the COVID-era flexibilities are ending. If your still prescribing controlled substances based on minimal telemedicine encounters, your exposed. If your using encrypted messaging to communicate with patients about controlled substance prescriptions, that encrypted messaging can be used against you as consciousness of guilt.

What should you do? Review your telemedicine practices immediately. Ensure your documenting thorough clinical encounters. If your practice relies heavily on remote controlled substance prescribing, consult with counsel about your exposure.

Criminal Liability – Prison Is Real

Under 21 U.S.C. 841, nurse practitioners face the same criminal penalties as any drug trafficker if they knowingly dispense controlled substances outside the course of professional practice. And the sentences are extremley serious.

Lets be clear about what “outside the course of professional practice” means. Its not just prescribing to someone who doesnt need the medication. It includes:

– Prescribing without adequate examination
– Prescribing without documented medical justification
– Prescribing in quantities that arent medically justified
– Pattern prescribing (same drugs to multiple patients regardless of individual needs)
– Prescribing for patients you know are diverting

And heres what most NPs dont understand – the sentences can be enhanced because you used your professional license to facilitate the crime. In the Ntukogu case (a pharmacist sentenced in 2024), the court specifically noted that thier professional status made the crime worse, not better.

Sentencing Reality:

– 70 months (Simonson, 2024) for prescribing to 54 patients
– Mandatory minimums apply based on drug type and quantity
– Conspiracy charges can extend sentences significantly
– Each prescription can be a separate count

Corporate settlements dont protect you. When major pharmacy chains pay hundreds of millions in settlements, the individual practitioners who wrote those prescriptions can still face prosecution. Your personal criminal liability is seperate from any employer resolution.

Civil Monetary Penalties – The Math

Lets do the calculation. The penalties was updated in February 2024:

– $18,759 per recordkeeping violation
– $80,850 per prescription violation
– $1,951,000 maximum for pattern of flagrant violations

$80,850. Per prescription. Each one.

If DEA identifies 50 problematic prescriptions, your civil exposure is over $4 million. And thats just civil penalties – doesnt include criminal fines, doesnt include restitution, doesnt include False Claims Act liability if Medicare or Medicaid was billed.

Heres how the math works in a typical case. Lets say DEA reviews 100 of your controlled substance prescriptions and finds 30 had inadequate documentation. 30 prescriptions × $80,850 = $2,425,500 in potential civil penalties. Add recordkeeping violations – maybe you didnt maintain proper DEA logs – and the exposure grows. Add the fact that many of those prescriptions were billed to Medicare or Medicaid, and now you have False Claims Act liability with treble damages on top.

Most nurse practitioners I talk to have no idea their exposure could reach millions of dollars. In my experiance, the NPs who understand this reality take compliance more seriously. They document more carefully. They consult their supervising physicians more frequently. They build the evidence of good faith that might save them.

State Board Parallel Proceedings – The Dual Track

When DEA investigates, your state nursing board usually finds out. Sometimes DEA notifies them directly. Sometimes the board sees it in the news. Sometimes a complaint gets filed with both agencies simultaneously. Either way, you end up fighting on two fronts.

Heres the problem: the standards are different. Federal criminal prosecution requires proof beyond reasonable doubt. State board discipline only requires preponderance of the evidence – basically, more likely than not. This means you can win the federal case and still lose your nursing license.

And heres what makes it worse for NPs specifically. Your nursing license is your foundation. Without it, you cant practice. Cant work. Cant earn. And nursing board proceedings often move faster then federal proceedings. You might face license suspension while the federal investigation is still ongoing.

The cascade works like this:

1. DEA investigation begins
2. State board notified (automatic in most states)
3. Board initiates there own investigation
4. You now face dual proceedings simultaneously
5. Anything you say in one proceeding can be used in the other
6. Even winning federally doesnt guarantee board reinstatement

NPDB reporting is permanent. If the board takes action, its reported to the National Practitioner Data Bank. This follows you for life. Even if you resolve the federal case favorably, that board action stays on your record.

What should you do? Make sure your attorney understands both the federal and state proceedings. Strategy in one affects the other. You need coordinated defense across both tracks.

Documentation That Saves You

I cant guarentee any outcome, but I can tell you what documentation matters. And for nurse practitioners specifically, theres documentation requirements that dont apply to physicians.

Supervision Consultation Documentation:

Every time you consult with your supervising physician about a complex controlled substance decision, document it. Date. Time. What you discussed. What the supervising physician advised. How that advice informed your decision.

This documentation does two things. First, it shows you operated within your collaborative agreement scope. Second, it supports a good faith defense – “I consulted my supervising physician and followed their guidance.”

Bottom line: if your collaborative agreement requires consultation for complex cases and you have zero documentation of consultations, you look like you exceeded your scope. Thats devastating for your defense.

Red Flag Resolution:

When you identify a red flag – patient paying cash, long distance travel, early refill request – document how you resolved it. Who did you call? What did they say? Why did you decide to proceed or refuse?

“Verified” written on a prescription is not adequate. Courts have specifically rejected this as insufficient documentation. You need specific, contemporaneous notes about what you actually did.

Clinical Justification:

For every controlled substance prescription, your chart should document why this patient needs this medication at this dose for this duration. “Chronic pain” is not adequate. You need specific clinical findings, treatment history, alternative treatments tried, rationale for controlled substance therapy.

Negotiation Options – CAP, MOA, Settlement

Your probly wondering if theres any way to resolve an investigation short of criminal prosecution. Actualy, this is your best option in most cases – if you can get it.

Corrective Action Plan (CAP)

An administrative resolution where you commit to specific compliance improvements. Enhanced documentation protocols. Staff training. Prescribing restrictions. Monitoring requirements. The benefit: you typically keep your DEA registration (with conditions). CAPs are available before criminal referral and typically cost $15,000-$50,000 to negotiate.

Memorandum of Agreement (MOA)

More formal then a CAP. A business agreement with DEA that specifies compliance measures over 3-7 years. Not an admission of liability. More on this later, but MOAs are often the best outcome in serious cases where criminal referral hasnt happened yet.

Pre-Criminal Settlement

If your case is heading toward criminal referral, settlement before that referral is critical. Once criminal referral occurs, settlement options largely disappear. Costs explode. Your leverage evaporates.

In my experiance, the window for these options is narrow. Most NPs wait too long. By the time they realize how serious the investigation is, the criminal referral has already happened.

Intervention Cost-Benefit Analysis

Their are genuinley difficult decisions about when to invest in legal defense. But the math is kinda clear – earlier is always better.

Pre-Investigation Compliance
Cost: $5,000-$25,000
Effectiveness: HIGHEST
What it buys: Potentially prevents investigation entirely

Subpoena Response Phase
Cost: $15,000-$40,000
Effectiveness: VERY HIGH
What it buys: Scope negotiation, timeline extensions, strategic positioning

Record Review Phase
Cost: $50,000-$100,000
Effectiveness: HIGH
What it buys: CAP/MOA negotiation, administrative resolution

Post-Indictment
Cost: $200,000-$1,000,000+
Effectiveness: LIMITED
What it buys: Plea negotiation, trial defense, damage control

The ROI of early intervention ranges from 40:1 to 200:1. Money spent at the subpoena phase prevents catastrophic expenses at the indictment phase. $30,000 spent early can prevent $300,000 spent later – and far better outcomes.

Why You Need Specialized Counsel Now

I mean it. If your reading this because you’ve received a DEA subpoena, records request, or any indication of investigation, you need to contact specialized counsel today. Not tomorrow. Today.

Every day you wait, the investigation advances. Every question you answer without counsel present becomes evidence. Every document you produce without strategic review narrows your options. And for nurse practitioners specifically, every day your supervising relationship is at risk. Every day your state board might be moving forward with parallel proceedings. Every day the window for a CAP or MOA resolution gets smaller.

Heres what I’ve learned from defending nurse practitioners through these investigations. The ones who contact counsel immediately – at the first sign of trouble – have dramatically better outcomes then those who wait. The ones who try to handle it themselves, who think cooperation will help, who believe “I didnt do anything wrong so I have nothing to worry about” – those are the ones who end up with criminal convictions, lost licenses, destroyed careers.

The difference between a CAP that lets you keep practicing and a criminal conviction that sends you to prison often comes down to intervention timing. $30,000 spent at the subpoena phase can prevent $500,000 spent at the indictment phase – and produce far better outcomes.

At Spodek Law Group, we’ve defended nurse practitioners through DEA investigations at every stage – from pre-investigation compliance audits through trial. We understand collaborative practice agreement dynamics. We understand the dual-liability trap with supervising physicians. We understand how NP-specific issues like state practice authority variations create unique vulnerabilities. We understand how to coordinate defense across both federal proceedings and state board investigations. We understand how to protect both your DEA registration and your nursing license while defending against federal investigation.

Todd Spodek and our team handle these cases nationally from our Brooklyn office. We’re available to consult immediately at 212-300-5196.

The window for effective intervention is narrow. The stakes are everything you’ve worked for. Your career. Your freedom. Your future. Your ability to ever practice as a nurse practitioner again.

Critical.

Thats what this moment is. But only if you act before its too late. Contact us today.