DEA Investigation of Nurse Practitioners

Last Updated on: 13th December 2025, 01:30 pm

When Your Collaborative Agreement Becomes Evidence Against You

Nurse practitioners face the exact same criminal penalties as physicians. The same mandatory minimums. The same sentencing guidelines. The same decades in federal prison. Under 21 USC 841, there’s no discount for having completed a nursing program instead of medical school. There’s no reduction for operating under a collaborative agreement. There’s no leniency because your state requires physician supervision. When the DEA decides to prosecute, you’re treated exactly like every other prescriber who violated the Controlled Substances Act. And often, you have less institutional support, less legal resources, and less experience navigating federal investigations.

This is the reality that nurse practitioners across America don’t understand until it’s too late. You spent years earning your degree. You obtained your state license. You secured a collaborative agreement with a supervising physician. You applied for your DEA registration. You thought you were protected. You thought the system of oversight and supervision meant someone was watching to make sure you stayed in bounds. What you didn’t realize is that the same collaborative agreement you rely on for professional legitimacy becomes the government’s roadmap to proving you exceeded your scope of practice – and knew you were doing it.

The numbers should terrify every nurse practitioner who prescribes controlled substances. Danielle Simonson received 70 months in federal prison for prescribing to 54 patients. Jeffrey Young – the self-proclaimed “Rock Doc” from Tennessee – faces up to 40 years per count after prescribing more than one million pills while maintaining a “party-like atmosphere” at his clinic. Lisa Hofschulz in Wisconsin was convicted of distribution resulting in death after prescribing opioids to 99 percent of her patients at $200 per month each. These aren’t outliers. This is what DEA enforcement against nurse practitioners looks like in 2025.

Same Penalties, Less Protection

Heres the uncomfortable truth that nursing programs dont teach. Under federal law, a nurse practitioner with prescriptive authority is treated identically to a physician when it comes to controlled substance violations. The DEA dosent care about your training pathway. They dont care that you completed a masters or doctoral nursing program instead of medical school. They dont care that your scope of practice might be narrower under state law. If you prescribe controlled substances outside the usual course of professional practice and without legitimate medical purpose, your facing the same mandatory minimums that apply to any drug dealer.

The difference is what happens before you get to that point. Physicians typically have hospital credentialing committees reviewing there prescribing patterns. They have malpractice insurers asking questions. They have peers in there specialty who notice when something seems off. Nurse practitioners – especially those in independent practice in full practice authority states – often have none of these safety nets. Your the one reviewing your own prescribing. Your the one deciding whether a patient’s request is legitimate. And when you get it wrong, there’s no institutional buffer between you and federal prosecution.

Lisa Hofschulz ran Clinical Pain Consultants in Wisconsin. The evidence at trial showed she prescribed opioids to 99 percent of patients who walked through the door. Every single one of them paid $200 per month for prescriptions. It wasnt a pain management clinic. It was a pill mill with a nursing license on the wall. She was convicted of conspiracy to distribute controlled substances AND distribution resulting in death. Her business partner husband was convicted alongside her. The clinic they built together became the crime scene that destroyed both there lives.

Your Collaborative Agreement Is Evidence Against You

OK so heres were nurse practitioners really get blindsided. You think your collaborative agreement protects you. You think it shows your operating under physician oversight. You think it proves your following the rules. When DEA investigates, they see something completly different.

The DEA looks at your collaborative agreement for one primary purpose: to establish what consultations SHOULD have happened. If your agreement requires you to consult the supervising physician on complex controlled substance decisions, and you cant produce documentation of those consultations, the government argues you knew you were exceeding your scope – and did it anyway. Your agreement becomes a checklist of requirements you failed to meet. Every independent decision you made without documented consultation becomes evidence of criminal intent.

Think about that for a second. The document you obtained to authorize your practice becomes the document prosecutors use to prove you practiced outside your authority. The supervising physician who signed your agreement gets dragged into the investigation too. The DEA wants to know: Did they actualy supervise? Should they have caught the red flags? Was this collaborative agreement just a piece of paper, or was there real oversight? If the answer is “just a piece of paper,” both of you are in trouble.

If your collaborative agreement requires consultation and you have no consultation records, you’ve handed the government proof that you knew the standard and violated it anyway.

The State-by-State Trap

The variation in nurse practitioner prescriptive authority across states creates a legal minefield that most NPs dont fully understand:

• 28 states plus Washington DC have full practice authority – nurse practitioners can prescribe controlled substances independantly without physician oversight
• 16 states require collaborative agreements
• 12 states require direct physician supervision
• Georgia and Oklahoma dont allow nurse practitioners to prescribe Schedule II controlled substances at all

What this means in practice is that conduct thats completly legal in one state is a federal crime in another. Not becuase the DEA changes its standards, but becuase your authorization to prescribe is contingent on state law. If you prescribe outside your state-authorized scope, your prescriptions lack legitimate medical purpose by definition. The DEA dosent have to prove you knew the drugs were going to be diverted. They just have to prove you werent authorized to prescribe them.

Heres the trap that catches nurse practitioners who move or practice across state lines. Your DEA registration is federal, but your prescriptive authority is state-determined. If you maintain practices in multiple states, you need separate DEA registrations in each state – and you need to meet each states specific requirements for collaborative agreements or supervision. What you can prescribe legally on Monday in Arizona might be illegal on Tuesday in Florida if you havent obtained the proper collaborative agreement.

The ARPO Strike Force – the Appalachian Regional Prescription Opioid Strike Force – has charged over 115 defendants collectively responsible for prescribing more than 115 million controlled substance doses. They specificaly target medical professionals in Alabama, Kentucky, Ohio, Virginia, Tennessee, and West Virginia. If your practicing in Appalachia and prescribing controlled substances, your in a region with heightened federal scrutiny. The same prescribing patterns that might fly under the radar in other regions get flagged immediatly here.

Heres something else most NPs dont realize. As of June 2023, all new and renewing DEA registrants – including nurse practitioners – must complete a one-time 8-hour training on opioid and other substance use disorders. This isnt just a checkbox requirement. Its creating new documentation expectations. If you completed the training but your prescribing patterns dont reflect the education you recieved, the government can argue you knew better and prescribed improperly anyway. Every compliance requirement creates a new standard you can fail to meet.

When Your Supervising Physician Drags You Down

The dual liability created by collaborative practice agreements is something most nurse practitioners never consider until there both sitting across from DEA investigators. When the DEA investigates a nurse practitioner, they also investigate the supervising physician. When they investigate the supervising physician, they pull in every nurse practitioner operating under that physician’s supervision. Your fates become intertwined in ways that destroy both careers.

The questions DEA asks about your supervising physician: Did they adequately supervise? Did they review charts as required? Should they have caught the red flags in your prescribing? Did they enable your patterns? If the supervising physician failed in there oversight duties, that failure becomes evidence that you were operating without proper supervision – which means you were operating outside your scope – which means your prescriptions lacked legitimate medical purpose.

Matthew Justin Sykes was a nurse practitioner in Virginia who worked at a substance abuse treatment program. He admitted to conspiring to regularly prescribe buprenorphine, clonazepam, and gabapentin without legitimate medical purpose. He got 60 months in federal prison. But the investigation didnt stop with him. The entire treatment program was scrutinized. Everyone who worked there had to answer questions about what they knew and when they knew it. When one person in the supervision chain falls, they often pull others down with them.

Your supervising physician’s failures become your criminal liability. There failures to catch your red flags become evidence that you knew you were operating unsupervised.

The Cases That Should Terrify You

Jeffrey Young called himself the “Rock Doc.” He was a nurse practitioner in Tennessee who ran Preventagenix, a clinic that federal prosecutors described as having a “party-like atmosphere.” He prescribed more than one million medically unnecessary controlled substance pills to hundreds of patients. He prescribed opioids to a pregnant woman. He had inappropriate physical relationships with patients he was prescribing to. He was trying to promote a self-produced reality TV show based on his persona. Every single one of those facts came out at trial. He faces up to 40 years in prison for each count involving distribution to a pregnant woman, and 20 years for every other count.

Purificacion Cristobal was a nurse practitioner in the Bronx who claimed to specialize in psychiatry. Between June 2019 and June 2020, she prescribed tens of thousands of doses of oxycodone without legitimate medical purpose. The government’s evidence showed she never performed physical examinations. She never ordered medical tests. She asked patients to “take their pick among different narcotics.” She was repeatedly warned that her patients were reselling or abusing the drugs she prescribed. She kept prescribing anyway.

Scott Eric Hansen was a nurse practitioner in Seattle whose state license was indefinitely suspended in 2024 after authorities found his prescribing posed an immediate danger to public health. Heres what makes his case particulary disturbing: after his state license was suspended, he kept prescribing. He wrote 54 more prescriptions for controlled substances to individuals AFTER the state had already determined he was dangerous. And before the suspension, he had prescribed controlled substances to himself at least 14 times. His DEA registration was finaly revoked in June 2025 – well after his state had already acted.

And then theres Angela Hughes in Idaho. A federal grand jury charged her and a patient who doubled as her medical assistant with conspiracy to distribute controlled substances. The allegations? They sold oxycodone and hydrocodone prescriptions through encrypted messaging on Telegram. Text message prescription sales. The government has the messages. They have the payment records. They have everything they need to prove the case becuase digital communications leave trails that cant be erased. When nurse practitioners get desperate or greedy, they sometimes turn to methods that create permanent evidence of there crimes.

The Hansen Warning – License Suspended, Still Prescribing

The Scott Hansen case reveals something that most nurse practitioners dont understand about the relationship between state licensing and DEA registration. There two separate systems. Losing one dosent automaticaly mean losing the other. Hansen’s state nursing license was suspended in 2024. But his DEA registration – the federal authorization to prescribe controlled substances – wasnt revoked until June 2025. During that gap, he continued writing prescriptions.

Think about what that means. A nurse practitioner whose state has determined poses an “immediate danger to public health” can continue prescribing controlled substances federaly until the DEA catches up and revokes there registration separatly. The systems dont talk to each other automaticaly. The protection you think exists – that your practice authority is contingent on maintaining proper credentials – has gaps that people exploit.

When nurses get desperate, they find these gaps. When there addicted – and Hansen prescribed to himself 14 times, suggesting possible personal substance issues – they use there professional credentials to feed that addiction. And when they get caught, the fact that they kept prescribing after state action creates devastating evidence of willful violation. You cant claim you didnt know you were doing something wrong when the state has already told you to stop.

What Actually Protects Nurse Practitioners

So what does work? What actualy protects nurse practitioners facing the risk of DEA investigation?

First: Take your collaborative agreement seriously. Not as a formality to obtain prescriptive authority, but as a working relationship that creates documented oversight. If your agreement requires consultations, make sure those consultations happen AND get documented. If your agreement specifies chart review percentages, make sure those reviews happen. The paper trail that protects you is the paper trail showing you followed the requirements, not just signed the document.

Second: Understand that full practice authority means full liability. Moving to a state with independent practice might feel like professional freedom, but it also means theres no supervising physician to share responsibility when things go wrong. Every prescribing decision is entirely yours. Every red flag you miss is entirely your failure. The independence that attracted you to full practice authority is the same independence that makes you solely responsible for federal criminal liability.

Third: Get DEA defense counsel immediatly upon any federal contact. Not after you’ve explained yourself. Not after you’ve tried to cooperate. Immediatly. The same cooperation trap that destroys physicians and pharmacists destroys nurse practitioners. DEA agents are not your colleagues. There not there to understand your clinical reasoning. There building a case. Every word you say can and will be used against you.

Fourth: Document your clinical decision-making contemporaneously. When you prescribe a controlled substance, your records should show why. Not just the diagnosis and the drug, but the reasoning that connects them. Why this medication? Why this dose? Why this duration? If the DEA ever reviews your charts, they’ll look for evidence of legitimate medical purpose. Sparse documentation invites the inference that there was no legitimate purpose – you were just writing scripts.

The Reality Nobody Wants to Hear

DEA enforcement against nurse practitioners is at historic levels. The opioid crisis created political pressure to prosecute everyone in the supply chain – physicians, pharmacists, and mid-level practitioners alike. The independent practice movement gave nurse practitioners more prescriptive authority than ever before. And the DEA is responding by treating NPs exactly like physicians when violations occur.

If your a nurse practitioner who prescribes controlled substances, you are a potential target. Not becuase your doing anything wrong. Becuase the enforcement framework dosent distinguish between your training pathway and a physicians. Becuase your collaborative agreement creates expectations that become criminal exposure when unmet. Becuase the state-by-state patchwork of prescriptive authority creates traps for practitioners who dont understand exactly where the lines are.

The time to prepare for a DEA investigation is before it happens. Know your collaborative agreement requirements and meet them with documentation. Understand your states scope of practice and stay within it. Have a DEA defense attorney identified before you need one. Know exactly what your authorized to prescribe and what requires consultation. And understand this: if federal agents ever contact you about your prescribing practices, the most important thing you can do is stop talking immediatly and call a lawyer.

Thats the reality of being a nurse practitioner with prescriptive authority in 2025. Same penalties as physicians. Same federal scrutiny. Same prison time. Your protection isnt your nursing license or your collaborative agreement. Your protection is understanding exactly what your facing before you face it.

The nursing profession fought for decades to achieve independent prescriptive authority. That fight was won in 28 states plus the District of Columbia. But with that hard-won independence comes a responsibility that the profession hasnt fully reckoned with yet. When you can prescribe Schedule II controlled substances without physician oversight, your also accepting full federal criminal liability without a physician to share that burden. The freedom to practice independantly is the freedom to face prosecution independantly.

Every nurse practitioner with a DEA registration should understand this: the government dosent distinguish between your training and a physicians when it comes to enforcement. The same mandatory minimums that put physicians in prison for decades will put you there too. The same investigative techniques that destroy medical practices will destroy yours. The same cooperation trap that convinces prescribers to talk themselves into convictions works exactly the same way on nurse practitioners. Your professional identity may be different from a physicians. Your federal criminal exposure is identical. The investigation has probly already started. The algorithms are running. The red flags are being tracked. The question is wheather you’ll be ready when they come for you.