More than a decade ago, Florida legislators passed laws to regulate so-called pill mills that once dominated South Florida and fueled the opioid crisis across the country.
The regulations slashed the number of pain clinics operating in the state. But a recent federal investigation into a South Florida opioid distribution ring highlights potential gaps in the state鈥檚 oversight.
In early June, federal prosecutors accused Dr. Sergei Margulian, 58, of Hallandale Beach, of , prescribing roughly 2.9 million pills out of clinics in Broward and Miami-Dade counties between 2021 and 2024.
Court documents show the case is tied to at least two Broward-based pharmacies, two pharmacists and two patient recruiters allegedly exchanging large amounts of cash for opioid prescriptions 鈥� filled repeatedly to the same individuals. The end goal was 鈥渢o generate and conceal large profits,鈥� according to indictments.
One pharmacist has pleaded guilty and surrendered her medical license, while the others have pleaded not guilty.
SA国际传谋 set out to understand how the accused doctor, pharmacists and recruiters sold millions of pills illegally for at least three years, without the state鈥檚 two marquee pill mill laws flagging issues sooner.
The legislation, passed during the height of the pain clinic crisis in 2009 and 2010, requires Florida Department of Health oversight of registered clinics and doctors to log information into a prescription drug tracking database.
Public records obtained by SA国际传谋 show that inspections by DOH pharmacists in 2023 and 2024 reported no issues at Margulian鈥檚 clinics: Sunrise Healing Health Center, in a Davie strip mall, and Healing Health Center, across from a high school in Hialeah.
That鈥檚 despite the Justice Department alleging, during that same period, the doctor was prescribing opioids to recruited clients 鈥渨ithout regard to medical need.鈥� The agency declined to comment for this story.
鈥溾�奍f you have four walls, a roof and clean equipment, basically you're halfway there,鈥� Lisa McElhaney, chief operating officer of the National Association of Drug Diversion Investigators, said of the state inspections. They focus on procedural items, rather than the doctor鈥檚 prescribing patterns, she said.
The second law 鈥� the Prescription Drug Monitoring Program (PDMP) 鈥� collects key information on patients who are prescribed opioids, but the Florida legislature designed the system to be 鈥減assive,鈥� according to former Palm Beach County State Attorney Dave Aronberg, who recently co-authored a book called "Fighting the Florida Shuffle," about prosecuting opioid abuse-related fraud.
鈥淭hey didn't want bells and whistles to go off when someone reached a certain threshold. So it's up to the doctor or the pharmacist to alert the authorities that something is amiss,鈥� Aronberg said.
The DOH did not respond directly to a list of questions sent by SA国际传谋, nor requests to interview the director of the state鈥檚 PDMP, but the agency instead provided a statement.
The goal of the PDMP is to 鈥減rovide the information maintained in the system to health care practitioners to augment their clinical decision making,鈥� DOH press secretary Isabel Kilman wrote.
鈥淭he PDMP does not have regulatory authority over licensees, and they do not conduct investigations into possible violations,鈥� Kilman said.
Meanwhile, Margulian and Olushola Yusuf, a Tampa-based pharmacist accused of participating in the scheme, are out on bond and have no restrictions on their medical licenses.
Florida law does not require licensed doctors to report an arrest to the Board of Medicine, but they are required to tell them of convictions and guilty pleas.
As part of Margulian鈥檚 bond with the federal court, he was his medical license. Yusuf was restricted from working in pharmacies.
No disciplinary actions show on the state鈥檚 records of Margulian or Yusuf.
Margulian declined to comment when reached by SA国际传谋. Yusuf and her public defender did not respond to requests for comment.
The Florida Board of Medicine directs all press inquiries to DOH, which said it could not comment 鈥渙n any possible cases until 10 days鈥� after the board finds probable cause for discipline.
Pill mills鈥� history in South Florida
In the late 2000s, loosely regulated clinics in Broward and Palm Beach counties fueled substance abuse, illegal drug sales and death across the country, according to past grand juries and law enforcement authorities.
Between August 2008 and November 2009, a new pain clinic opened in Broward and Palm Beach counties every 3 days on average, a found. Four out of every 10 oxycodone pills (30 mg) in the U.S. were sold in Florida from 2009 through 2010, according to The Palm Beach Post. The Drug Enforcement Agency pinpointed South Florida as the hub for trafficking pills to other states, the Post reported.
Florida legislators were forced to act.
After a politically-fraught process, they passed a law creating a prescription drug monitoring database, administered by the health department. The program requires doctors to log whom they prescribe opioids to and review their patient records beforehand. The measure became law in 2009 but wasn鈥檛 fully funded until two years later.
Another law passed in 2010 mandates doctors register their clinics with the state and submit to a yearly inspection. It also forbids doctors who had their licenses revoked or were convicted of a felony drug crime from running a clinic.
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The regulations worked. The number of clinics in Florida fell from more than 900 in 2009 to around 370 by 2014, according to a federally-funded .
鈥淲e've gone from being known as the 'oxy express' to being a role model for our sister states,鈥� a former commissioner of the Florida Division of Law Enforcement told
Former Florida Attorney General Pam Bondi, who now serves as U.S. Attorney General, included the PDMP and subsequent prosecutions of pill mills as signature achievements on her .
Some studies associated the implementation of the PDMP and pill mill law to less
The scheme
From 2020 to 2023, Betscy Kurian, of Coral Springs, was the pharmacist in charge at Chans Pharmacy Plus. The Pembroke Pines pharmacy was a pill mill, according to related to Kurian鈥檚 guilty plea.
For years, cash-paying customers and out-of-state patients received the same 鈥渇actory-like鈥� dosages of opioids and regularly cycled through the pharmacy, the documents note.
To a licensed pharmacist, these would typically be warning signs that patients are abusing or trafficking opioids.
鈥淥ne customer routinely visited Chans to fill prescriptions for several individuals for large quantities of Oxycodone 30mg, paying approximately $800 in cash per bottle,鈥� the plea document stated.
Kurian told her boss, Yusuf, of the red flags but was instructed to continue dispensing.
In October 2024, Kurian to one felony count of conspiracy to distribute and dispense a controlled substance.
鈥淭hese types of pill schemes and those who profit from them rely on people who will simply do as they are told. Betscy did not design this scheme or profit from it, but she was essential and culpable because of her position as a pharmacist,鈥� Jude Faccidomo, Kurian鈥檚 Miami-based attorney, told SA国际传谋 in a statement.
鈥淲hat is important is she knows she should have known better and that is why she immediately accepted responsibility and (pleaded) guilty,鈥� he wrote.
A date for sentencing has not been set. That same month, Kurian her medical license to the Board of Pharmacy and promised never to apply as a pharmacist again in Florida.
Feds go after alleged pill mills
Eight months after Kurian鈥檚 guilty plea, federal prosecutors went after other medical providers and alleged co-conspirators.
Olushola Yusuf, 59, of Tampa, is a registered pharmacist who ran and owned Chans, the indictment said. Yusuf also ran Striderite Pharmacy in Margate.
Yusuf worked with Saman Cala Gimenez, 53, of Tampa, who recruited patients. Patients went to the pharmacies and paid large sums of cash for their opioid prescriptions to be filled,
Between 2021 and 2024, Yusuf, Gimenez and Kurian dispensed around 335,000 pills of oxycodone from the two Broward County pharmacies alone, according to the indictment.
Yusuf and Gimenez have both pleaded not guilty. A lawyer for Gimenez did not respond to a request for comment. In a court filing, Yusuf invoked her Fifth Amendment to not incriminate herself.
Out of clinics in Davie and Hialeah, Margulian worked with Damary Mendez, 53, of Miami, who recruited patients and sent the doctor 鈥渓ists that contained patients' names, dates of birth, and the number of pills of oxycodone to prescribe to them,鈥� prosecutors said. Margulian wrote them electronically.
A lawyer for Mendez did not respond to a request for comment.
While prosecutors did not directly name Yusuf and Kurian as co-conspirators, they said Margulian鈥檚 case is with overlapping facts and witnesses.
Margulian and Mendez have both pleaded not guilty.
Gimenez, Margulian, Mendez and Yusuf were all charged over two days in June.
One employee of a business neighboring Margulian, who did not wish to be named for fear of reprisal, told SA国际传谋 he was working when police raided Margulian鈥檚 Davie clinic in mid-June.
He saw at least a dozen police vehicles outside that day, he said. Officers then went door-to-door to businesses asking if anyone saw anything suspicious at the clinic.
The employee said expensive-looking cars came at all hours of the night to the small strip mall clinic in Davie.
Barriers to stopping ongoing opioid scams
On 2023 and 2024 inspection forms, senior pharmacists working for the DOH wrote 鈥淵es鈥� next to sections that claimed Margulian regularly saw his clients and administered opioids only through individualized treatment plans, according to the documents.
Before an inspection, doctors usually make sure everything is in place beforehand, according to McElhaney.
鈥�(Inspectors are) not evaluating the viability of the information,鈥� she said.
McElhaney, who served as a Broward Sheriff鈥檚 Office deputy and drug investigator for years, said these cases are difficult for law enforcement to pursue. They require a level of training and knowledge most police officers don鈥檛 have.
Plus, patients who receive the illicit prescriptions have little incentive to help the police, she said. Federal privacy laws also make it difficult to proactively investigate clinics.
鈥溾�奅ven if I believe that doctor's a bad doctor, I cannot walk in as a law enforcement officer, state or federal, and look at any patient records,鈥� McElhaney said.
They have to be subpoenaed and the records have to show 鈥渁 pattern of what would not be any type of legitimate prescribing,鈥� she said.
During the time he is accused of prescribing nearly 3 million oxycodone pills, Margulian had an active license with the DEA to prescribe opioids to clients.
The DEA has not responded to a request for comment on when they learned about his alleged conduct.
Prescriptions assigned by Margulian and filled by the Broward pharmacies might have been caught earlier if the state鈥檚 PDMP was more 鈥渁ctive,鈥� according to Aronberg.
States like North Carolina, Kansas, Wyoming and Texas all have systems in place within their PDMPs to proactively flag law enforcement or medical boards when irregularities arise.
鈥溾�奣he state regulators should have some ability to see that there's a scam going on under their noses,鈥� said Aronberg.
