Telemedicine Prescribing Investigation

Telemedicine Prescribing Investigation – The Ryan Haight Act Is Coming For You

If you have been prescribing controlled substances via telemedicine, you need to understand something that will change how you think about your entire practice. The federal government has a law specifically designed to prosecute exactly what you have been doing. The Ryan Haight Online Pharmacy Consumer Protection Act. And the COVID-era flexibilities that made your prescribing legal are ending.

The first federal prosecution of a telehealth company for illegal drug distribution has already happened. Done Global – a telemedicine company that prescribed ADHD medications – saw its CEO Ruthia He and clinical president David Brody convicted on conspiracy and distribution counts. The HHS Office of Inspector General called it “one of the most egregious abuses of telehealth” they have ever seen.

They used the word “first.” More prosecutions are coming.

The Boy Who Died and the Law That Bears His Name

In 2008, Congress passed the Ryan Haight Online Pharmacy Consumer Protection Act. It was named after an 18-year-old who died from an overdose of Vicodin. A telemedicine doctor prescribed that Vicodin without ever examining Ryan Haight in person. An online pharmacy delivered it directly to his door. He took the pills and died.

His death created a federal law that says this: you cannot prescribe controlled substances to a patient unless you have conducted at least one in-person medical evaluation of that patient. No exceptions in the statute. One in-person exam, minimum, before you can prescribe Schedule II through V controlled substances.

Heres the system revelation that should terrify every telemedicine prescriber. The Ryan Haight Act has been federal law since 2008. Its been on the books for over 15 years. The in-person examination requirement has never been repealed. What happened during COVID was a temporary flexibility – emphasis on temporary – that allowed practitioners to ignore the requirement during the public health emergency.

That flexibility is ending. December 31, 2025. After that date, every controlled substance prescription you write to a patient you havent examined in person violates federal law. Every single one.

The First Prosecution – Done Global

Done Global was a telehealth startup that prescribed Adderall and other stimulants online. Fast, efficient, convenient. Exactly what patients wanted. Exactly what the telemedicine market demanded. And now exactley what federal prosecutors call drug distribution.

A San Francisco jury convicted Ruthia He, the CEO, and David Brody, the clinical president, on two conspiracy counts and four counts of distribution of controlled substances. The prosecution wasnt about technical violations of the Ryan Haight Act. It was about what prosecutors characterized as systematic prescribing without legitimate medical purpose.

The Done Global prosecution was explicitly described as the “first federal prosecution of alleged illegal drug distribution by a telehealth company.” When federal prosecutors use the word “first,” there telling you that more are coming. Done Global established the template. Other telehealth operations will follow.

Heres the irony that should make telemedicine prescribers uncomfortable. “Done Global” – a company name suggesting efficiency and completion – became the first company prosecuted for the efficient distribution of controlled substances. The same efficiency that made the company successful made it a prosecution target.

The HHS Office of Inspector General called the case “one of the most egregious abuses of telehealth” the agency has seen. That language signals enforcement priority. When federal agencies call something “egregious,” they are building the narrative for expanded prosecution.

The 2 Minute 20 Second Consultation

Dr. Raphael Tomas Malikian ran a telemedicine practice called “Happy Family Medicine.” Federal prosecutors arrested him for prescribing controlled substances – including opioids – after telemedicine consultations that lasted as little as 2 minutes and 20 seconds. Some consultations were conducted entirely via text message.

Two minutes and twenty seconds. Thats the number federal prosecutors used to prove illegitimate prescribing.

Heres the hidden connection that destroys telemedicine prescribers. Your telemedicine platform logs everything:

• Session length
• Session recordings
• Patient count
• Prescription patterns

When the DEA subpoenas your platform provider, they get all of it. Every 5-minute appointment. Every 3-minute follow-up. Every pattern that looks like assembly-line prescribing.

The Malikian case demonstrates what prosecutors consider evidence of criminal conduct. Short appointments. No physical exams. No diagnostic tests. Pattern prescribing across patients. Text-message consultations. If your telemedicine practice looks like his, you have the same criminal exposure.

Your platform knows how long your appointments last. The DEA can find out. And 2 minutes 20 seconds is the number that ends careers.

Why Your State Law Doesn’t Protect You

Heres the paradox that catches telemedicine prescribers by surprise. Your state may explicitly permit telemedicine prescribing of controlled substances. Your state medical board may have approved the practice. You may be completly compliant with every state regulation. And you can still face federal prosecution for the exact same prescribing.

The Ryan Haight Act is federal law. Federal law preempts state law on controlled substances. When Congress passed the Controlled Substances Act, it established federal authority over Schedule II through V medications. State authorizations dont override federal prohibitions.

The consequence cascade is brutal:

• Your state permits telemedicine prescribing
• You comply with state law
• You beleive your legal
• Federal prosecutors charge you under Ryan Haight
• Your state compliance is not a defense
• You face federal criminal penalties – including prison, fines, and permanent loss of your DEA registration

Some states have laws that directly conflict with Ryan Haight Act requirements. Providers practicing under those state laws think there safe. There not. The last documented enforcement of Ryan Haight against a physician was in July 2011 – but the DEA recently reiterated its “strict interpretation” of the requirements. The threat is real. The law is enforcable. Your state license dosent protect you from federal prosecution.

The COVID Cliff – December 31, 2025

During the COVID-19 public health emergency, the DEA temporarily suspended Ryan Haight’s in-person examination requirement. Providers could prescribe controlled substances via telemedicine to patients they had never examined in person. This wasnt a change in the law. It was a temporary flexibility that has been extended multiple times.

That flexibility is currently scheduled to end December 31, 2025.

Heres the inversion that should terrify every telemedicine prescriber. COVID flexibilities felt like freedom. Expand your practice. See more patients. Prescribe without geographic limitations. Build relationships with patients you’ve never met in person. Freedom.

When the flexibility ends, that freedom becomes criminal exposure.

The consequence cascade works like this:

• You built a telemedicine practice during COVID
• You relied on the flexibilities
• You established relationships with patients youve never examined in person
• Those patients expect continued prescriptions
• December 31, 2025 arrives – flexibility ends
• You face a choice: abandon your patients or continue prescribing in violation of federal law

If you continue prescribing to maintain care continuity, every prescription after the deadline becomes a potential federal charge. Each prescription to a patient you havent examined in person violates the Ryan Haight Act. Prosecutors dont have to prove you were running a pill mill. They just have to prove you prescribed without the required in-person examination.

The Evidence Trail You Created

Heres the irony that makes telemedicine prosecution easier then traditional prescriber cases. The same technology that makes telemedicine possible creates the perfect evidence for prosecution.

Traditional in-office prescribing leaves limited evidence. Patient charts. Prescription records. But no recording of what actualy happened in the exam room. No timestamp proving how long the appointment lasted. No electronic log of every click and keystroke.

Telemedicine is different. Your platform logs everything.

Session recordings – many platforms record video consultations by default. Prosecutors can watch exactly what happened. Did you conduct a meaningful examination? Did you ask relevant questions? Or did you process patients like an assembly line?

Session length – your platform knows how long each appointment lasted. The DEA can subpoena that data. When prosecutors show a jury that you averaged 4-minute appointments for controlled substance prescriptions, the jury concludes you werent practicing legitimate medicine.

Prescription patterns – electronic prescribing creates perfect records. Same medications, same dosages, same quantities across multiple patients. Pattern prescribing is easier to prove when every prescription is digitaly logged.

Patient volume – your platform knows how many patients you saw. Fifty patients a day sounds like a successful practice until prosecutors call it a distribution operation.

The technology you used to build your telemedicine practice is the technology that will convict you. Every efficiency you created left a digital trail. Every short appointment is timestamped. Every prescription is logged. The evidence exists. The only question is wheather the DEA decides to look at it.

Why “Rarely Enforced” Should Terrify You

The Ryan Haight Act has been described as “rarely enforced.” The last documented case against a physician was in July 2011. Providers read this and assume the law is effectively dead. They assume telemedicine prescribing is safe becuase no one gets prosecuted.

That assumption is going to destroy careers.

Heres the system revelation that explains why “rarely enforced” is actualy terrifying. The DEA recently “reiterated its strict interpretation of Haight Act requirements.” That language signals a change in enforcement priorities. When federal agencies start talking about “strict interpretation,” there preparing to prosecute.

The consequence cascade for enforcement changes is devastating:

• “Rarely enforced” creates complacency
• Providers assume risk is low
• They build practices based on that assumption
• DEA changes enforcement priorities
• Mass prosecution wave begins
• Providers who thought they were safe are destroyed

Done Global wasnt prosecuted under the Ryan Haight Act specifically – but it demonstrated that the federal goverment is willing to prosecute telemedicine prescribing as drug distribution. The tools exist. The precedent is established. The only question is how broadly enforcement expands.

The DEA has proposed enhanced recordkeeping requirements specifically for telemedicine. Why would they build recordkeeping infrastructure for a type of prescribing they dont intend to scrutinize? The infrastructure is enforcement infrastructure. The records are prosecution records. The agency is preparing.

The $784 Million Telemedicine Fraud That Shows Where Enforcement Is Heading

The scale of federal telemedicine enforcement is expanding rapidley. Consider the numbers from recent cases.

One telemedicine company owner faced charges in a superseding indictment for a $784 million health care fraud scheme involving illegal kickbacks and tax evasion. Seven hundred eighty-four million dollars. Thats not a typo. Thats the scale of telemedicine fraud that federal prosecutors are now targeting.

An Alabama doctor pleaded guilty to a $6 million telemedicine health care fraud scheme. A national healthcare fraud takedown resulted in 324 defendants charged in connection with over $14.6 billion in alleged fraud – and telemedicine schemes were a significant component.

The federal goverment isnt treating telemedicine prescribing as minor regulatory violations. There treating it as organized drug distribution deserving the same enforcement resources as traditional trafficking organizations.

Heres the uncomfortable truth that telemedicine providers dont want to face. The COVID pandemic created an explosion of telemedicine prescribing. Millions of patient relationships were established without in-person examinations. Billions of dollars flowed through telemedicine platforms. Federal prosecutors saw all of that. They built enforcement infrastructure. They waited for the right moment. That moment is coming.

The Done Global prosecution wasnt a random enforcement action. It was a signal. The federal goverment has decided that telemedicine prescribing abuse is a priority. The resources are allocated. The precedents are established. The cases are being built.

If your practice relies on telemedicine prescribing of controlled substances, you are operating in an enforcement environment that is fundamentaly different then it was during COVID. The flexibility that protected you is ending. The scrutiny that replaces it has already begun.

The Transition Patients Problem

Heres the consequence cascade that will trap telemedicine prescribers who havent planned for the cliff. You have patients. You built relationships with them. There relying on prescriptions you provide via telemedicine. Some of them have been your patients for years. They trust you. They depend on you.

December 31, 2025 arrives. The flexibility ends. What do you do?

Option one: stop prescribing to patients you havent examined in person. Your patients loose access to medications they need. Some may suffer withdrawal. Some may turn to illicit sources. You’ve abandoned them.

Option two: continue prescribing to maintain care continuity. Every prescription you write after the deadline violates federal law. Each one is a potential count. You’ve become a federal criminal.

Option three: scramble to conduct in-person examinations before the deadline. But you have hundreds of patients. The logistics are impossible. You cant examine everyone in time.

The telemedicine model created this trap. During COVID, it was efficient to see patients virtually. No geographic limitations. No scheduling constraints. You could build a practice with patients scattered across multiple states, none of whom you ever met in person.

That efficiency becomes exposure. Those scattered patients cant easily come to your office for in-person exams. The practice model that made telemedicine successful makes Ryan Haight compliance nearly impossible.

The providers who recognized this problem early are already transitioning. There requiring in-person visits. There limiting controlled substance prescriptions to patients they’ve examined. There building compliance into there practice model.

The providers who assumed the flexibility would be extended indefinately, who assumed “rarely enforced” meant “never enforced,” who assumed there practice model would remain viable forever – these providers are facing a cliff with no way to stop.

What Happens After You’re Investigated

Federal investigation of telemedicine prescribers follows a pattern that should concern every provider.

First, the DEA subpoenas your telemedicine platform. They get everything. Session recordings. Session lengths. Patient counts. Prescription patterns. Your entire practice history in digital form.

Second, they analyze patterns. Short appointments. High volume. Repeat prescriptions. Pattern prescribing. Every metric that made your practice efficient becomes a metric that proves criminal operation.

Third, they interview patients. Some will describe meaningfull care. Others will describe 3-minute video calls that felt like prescription vending machines. The patients who felt processed become prosecution witnesses.

Fourth, indictment. Each prescription that prosecutors characterize as illegitimate becomes a count. If you wrote 500 controlled substance prescriptions via telemedicine, you face 500 potential counts. At 20 years maximum per count under 21 USC 841, your theoretical exposure is astronomical.

Fifth, plea pressure or trial. With your practice records in digital form, the evidence is overwhelming. With patients testifying about short appointments, the narrative is established. Most telemedicine prescribers facing federal charges will plead guilty.

What You Should Do Right Now

If your a telemedicine prescriber of controlled substances, you need to understand your exposure and prepare for the cliff that is coming.

Know the deadline. December 31, 2025. After that date, the COVID flexibilities end. Every controlled substance prescription to a patient you havent examined in person violates federal law. Plan accordingly.

Establish in-person relationships. If you have patients receiving controlled substance prescriptions via telemedicine, arrange in-person examinations before the deadline. Document those examinations thoroughly. Create the paper trail that shows Ryan Haight compliance.

Review your appointment patterns. If your telemedicine platform shows that your averaging 5-minute appointments for controlled substance prescriptions, understand what that looks like to prosecutors. Adjust your practice before its to late.

Document thoroughly. Every telemedicine consultation for controlled substances should document the clinical reasoning for prescribing. Why this medication? Why this patient? What alternatives were considered? The documentation is your defense.

Consult an attorney. If your practice has been prescribing controlled substances via telemedicine without in-person examinations, you may already have exposure. Understand your risk. Plan your transition. Protect yourself.

The Done Global prosecution was the first. It wont be the last. The telemedicine prescribers who survive the coming enforcement wave will be those who recognized the cliff and prepared for it. The ones who assumed “rarely enforced” meant “never enforced” will learn otherwise.

The Ryan Haight Act is federal law. It has been since 2008. Ryan Haight died becuase a doctor prescribed Vicodin without ever examining him. Congress passed a law to prevent that. The COVID emergency temporarily relaxed it. That relaxation is ending.

Get compliant. Get documented. Get legal advice. The prescriptions you wrote yesterday could become the charges you face tomorrow.

The License Consequences Beyond Criminal Charges

Even if you avoid federal criminal prosecution, Ryan Haight violations can destroy your career through administrative channels. The DEA can revoke your registration. State medical boards can suspend or revoke your license. Medicare and Medicaid can exclude you. These consequences dont require criminal conviction. They require only a finding that you violated prescribing regulations.

Heres the consequence cascade that catches telemedicine providers:

• DEA investigates your practice
• They find Ryan Haight violations – prescriptions to patients you never examined in person
• They dont pursue criminal charges becuase your case isnt extreme enough
• Instead, they initiate administrative proceedings
• Your DEA registration is revoked
• Without DEA registration, you cant prescribe controlled substances
• Without prescribing authority, your telemedicine practice collapses
• Your medical board takes notice – they investigate
• They find the same violations – they suspend or revoke your medical license
• Your career is over – and you were never criminaly charged

The threshold for administrative action is lower then criminal prosecution. Prosecutors need proof beyond reasonable doubt. Administrative agencies need only preponderance of evidence – more likely then not. You can avoid prison and still loose everything you built.

Telemedicine prescribers who think “I just wont get prosecuted” are missing the point. Criminal charges are the worst case. But administrative consequences can be equaly devastating – and there much easier for the goverment to pursue. The Ryan Haight Act creates exposure at every level. Criminal. Administrative. Professional. Financial.

Protect yourself before the cliff arrives. The prescriptions you write today determine your career tomorrow.