"The only way to make progress against opiate abuse is to fight it on multiple fronts at the same time," Acting Attorney General John J. Hoffman said. "Even as we pursue criminal cases against heroin rings and pill distribution mills, we also must take strong action against prescribers and dispensers who make pills available for abuse. By putting doctors and pharmacists who illegally peddle this mayhem into prison, and/or by revoking or suspending licenses or CDS registrations for non-criminal matters, we are sending a clear message to other practitioners who may be tempted to let greed or negligence corrupt their practice."

Since July 2013, the State has filed 50 public actions directly related to the indiscriminate prescribing or dispensing of Controlled Dangerous Substances (CDS) in New Jersey. Of these, 23 cases have been filed seeking disciplinary action against licensees of professional boards within the Division of Consumer Affairs, including actions against 15 physicians, seven pharmacies or pharmacists, and one dentist.

The State filed the 27 additional orders pertaining to prescribers’ or dispensers’ New Jersey CDS registrations. While a prescriber’s or dispenser’s license is granted by a professional licensing board, those licensees and pharmacies also must obtain a CDS registration from the Director of the Division of Consumer Affairs. Revocation of the CDS registration protects the public by ensuring that CDS cannot be prescribed or dispensed, even if the licensee returns to practice or a pharmacy reopens. The Director will only reinstate a CDS registration upon determining that a return to prescribing or dispensing is in the public interest.

“During the past 15 months, New Jersey has taken effective action against prescribers and other practitioners who are accused of endangering the public through the negligent prescribing or dispensing of narcotic painkillers,” Division of Consumer Affairs Acting Director Steve Lee said.

To date, these disciplinary actions have led to filed orders which include the revocation, surrender, or temporary suspension of the licenses of 13 physicians; seven pharmacists, pharmacies, or pharmacy technicians; and one dentist. They have also resulted in the revocation or temporary suspension of 26 CDS registrations. The remaining actions are still pending.

These actions have had a measurable impact in protecting the public. Among the physicians whose licenses have been revoked or temporarily suspended, just eight were responsible for writing more than 45,000 prescriptions representing 3.2 million doses of CDS medications during 2012. Thanks to these enforcement actions, the CDS prescribing by these doctors has been reduced to zero.

Highlights from recent criminal cases and non-criminal administrative complaints and actions include:

Vincent Esposito, M.D. and Srinivasa Raju, R.P.: Last year, the Division of Criminal Justice indicted Dr. Vincent Esposito, a practicing doctor in Madison, N.J., and pharmacist Srinivasa Raju on charges they conspired to prescribe thousands of oxycodone pills to individuals without a medical examination and without medical need. Esposito pleaded guilty in December to a second-degree narcotics distribution charge, which can be reduced to a third-degree charge upon sentencing. Raju faces pending second-degree narcotics distribution charges.

William C Kropinicki, M.D.: In December 2012, William C. Kropinicki, a doctor who had an office in Lawrence, N.J., was sentenced to seven years in state prison for selling prescriptions for Percocet to a drug dealer in the names of purported patients he never treated or examined. The charges resulted from an investigation by the Division of Criminal Justice, the Division of Consumer Affairs Enforcement Bureau and the Bordentown City Police Department.

Clifton Howell, M.D.: In September 2011, Dr. Clifton Howell was sentenced to three years in state prison for his role in a narcotics ring that defrauded Medicaid and unlawfully distributed prescription pain pills, such as OxyContin and Percocet, on the black market in Hudson, Bergen, Ocean, Morris, and Monmouth counties. The leader of the ring, Louis Lisi, was sentenced to 22 years in prison. The charges stemmed from Operation MedScam, a joint investigation by the New Jersey Office of the Insurance Fraud Prosecutor's Medicaid Fraud Control Unit and the Jersey City Police Department’s Special Investigation Unit.

Vladimir Kleyman R. P. and Prescriptions R Us, LLC: On October 29, 2014 the Attorney General obtained a Consent Order in which Kleyman, a pharmacist and part owner of “Prescriptions R Us” pharmacy in Lakewood, agreed to the temporary suspension of his pharmacist license as well as of the pharmacy’s permit to operate as a pharmacy. According to an administrative complaint filed by the Attorney General on October 20, 2014, Kleyman and Prescriptions R Us failed to fulfill their obligation to regularly provide the New Jersey Prescription Monitoring Program (NJPMP) with information on prescriptions filled for medications classified as CDS. State law has mandated this NJPMP reporting requirement since September 1, 2011.

Kleyman and Prescriptions R Us allegedly filled thousands of CDS prescriptions during that time, but failed to report a single instance of such dispensing to the NJPMP. This alleged failure denied physicians the ability to learn accurate information about the CDS drugs their patients may have obtained; prevented other pharmacies from discovering wether patients are at risk of harmful drug interactions; and enabled Prescriptions R Us to avoid regulatory scrutiny of the drugs it dispensed; all of which put patients at substantially increased risk of harm.

The State’s action follows Kleyman’s August 2014 guilty plea to federal charges of bribing a physician and committing healthcare fraud relating to his dispensing of CDS. He admitted to billing and obtaining reimbursement for items not dispensed, and falsifying the quantity and dosages of medications dispensed in order to support fraudulent insurance billing.

Ali G. Mansour, M.D.: In July 2014, the Board of Medical Examiners obtained the revocation of the medical license of. Mansour, a Somerset physician accused of engaging in a grossly negligent pattern of prescribing narcotic painkillers that put patients at risk of addiction, and of continuing to prescribe increasing dosages to patients despite clear evidence that they were abusing drugs. Mansour may reapply for his medical license a full two years after the effective date of his revocation, but he will remain permanently prohibited from prescribing CDS in New Jersey. He also is required to pay $150,000, including a civil penalty and reimbursement of the State’s costs.

According to the Attorney General’s administrative complaint, Mansour often prescribed excessive amounts of potentially addictive drugs such as oxycodone or alprazolam to certain patients, even though their specific diagnoses did not warrant such large quantities of drugs. In each patient’s case, Mansour was presented with evidence of apparent drug use. For some patients these included positive tests for heroin, cocaine, or prescription opiates that Mansour had not prescribed. However, he continued to prescribe increasing amounts of CDS to these patients.

Adam C. Gilliss. M.D.: In July 2014, the Board of Medical Examiners temporarily suspended the license of Gilliss, a Merchantville physician found by the Board to have engaged in a grossly negligent pattern of prescribing narcotic painkillers that put his patients at risk of addiction, and/or facilitated their possible illegal diversion of dangerous opiates. A committee of the Board noted in a hearing report that Gilliss “knew that he was perceived to be an ‘easy mark’ for drug-seeking patients, but took no measures to alter his lax practices,” until he became aware the Board was investigating him.

According to the Attorney General’s administrative complaint, Gilliss prescribed potentially addictive painkillers to multiple patients for months or years at a time. In each case, he began this prescribing practice without sufficiently evaluating the patients to determine whether the prescriptions were medically necessary or justified. He also continued this practice, at times increasing the dosage or changing the narcotics prescribed, without evaluating the patients to determine whether they were at risk of drug dependency.

Liviu T. Holca, M.D.: Following a joint investigation led by the Division of Consumer Affairs’ Enforcement Bureau, the Ocean County Prosecutor’s Office, the U.S. Drug Enforcement Administration through its Camden Resident Office, and the Stafford Police Department, the Board of Medical Examiners in June 2014 obtained the temporary suspension of Holca’s license.

The joint investigation led to Holca’s January 2014 arrest by Ocean County law enforcement personnel, and the filing of criminal charges that include prescribing CDS without medical necessity.

During the joint investigation, Holca allegedly wrote prescriptions for hundreds of Percocet and Xanax pills for an undercover officer whom Holca believed to be a patient. The undercover officer repeatedly told Holca that she did not need the pills for any medical reason, but that they made her “feel good” and that she gave them to friends. In addition, data obtained from the New Jersey Prescription Monitoring Program demonstrated an alleged pattern by Holca of indiscriminately prescribing controlled opiate painkillers to multiple patients between May 2011 and December 2013.

These civil enforcement actions are part of the Attorney General’s comprehensive strategy to fight the diversion and abuse of opiates.

Other elements include, but are not limited to:

• The Attorney General’s wide-ranging directive, issued October 28, 2014, to ensure that police and prosecuting agencies throughout the State take critical steps to address the crisis of heroin and prescription painkiller abuse. The directive advances a number of important initiatives and legislation launched and signed into law by Governor Christie. Several sections will strengthen investigations and prosecutions targeting heroin dealers and those who profit by diverting prescription pain pills into the black market, including corrupt doctors and pharmacists. Other sections will help track and prevent overdoses and will bolster effective use of New Jersey’s Drug Court program so addicted individuals are treated rather than imprisoned when treatment offers a better chance of turning offenders from a life of crime.

• The expansion of Project Medicine Drop, which enables New Jerseyans to dispose of their unused and expired medications at participating police departments, sheriff's offices, and State Police barracks. The Division of Consumer Affairs has installed 102 Project Medicine Drop boxes at law enforcement agencies across New Jersey. Since its launch in November 2011, New Jerseyans have dropped off a total of 36,533 pounds, or 18.3 tons, of excess medications. Of that total, 48 percent was dropped off during the first three quarters of 2014 alone.

• The creation of the Pain Management Council, an advisory body that will help the Division of Consumer Affairs develop best practice recommendations for New Jersey's healthcare professionals. The goal is to create voluntary guidelines that will enable prescribers to provide pain management, while maintaining effective controls to prevent drug diversion and abuse.

• The expansion of the New Jersey Prescription Monitoring Program (NJPMP), to include direct data-sharing with the PMPs maintained by the States of Connecticut and Delaware, and efforts to build a similar data-sharing partnership with New York. To date, approximately 41 percent of New Jersey's eligible prescribers and pharmacists are registered as users of the NJPMP. This statewide database tracks the prescription sale of all drugs classified as Controlled Dangerous Substances (CDS) or Human Growth Hormone into New Jersey.

• New, mandatory security requirements for New Jersey prescription blanks. Prescribers will be required to exclusively use the new prescription blanks as of November 3, 2014.

• The Division's May 2013 adoption of a fully modern set of Best Practices for Pharmacy Security as recommendations for voluntary compliance by New Jersey's pharmacies. The Division developed the Best Practices for Pharmacy Security after bringing pharmacy industry, regulatory, and law enforcement groups together for two Pharmacy Security Summit meetings in 2012.

For more information on the New Jersey Division of Consumer Affairs' initiative to halt the diversion and abuse of prescription drugs, view the Division's NJPMP website, and the Division's Project Medicine Drop website.

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