After two years of legal filings and a seven-week criminal trial, the doctors who operated Physicians Pain Specialists of Alabama (PPSA) have been sentenced to two decades behind bars and ordered to pay restitution fines exceeding $25 million.
Xiulu Ruan and John Patrick Couch were sentenced, respectively, to 21 and 20 years in federal prison last week by U.S. District Court Judge Ginny Granade after being convicted in February of 19 charges ranging from distributing controlled substances to violating the Racketeer Influenced and Corrupt Organizations (RICO) Act.
Both sentences were a variance from set guidelines and significantly less than prosecutors initially sought, as Granade said it was an “unusual case,” as PPSA was “not a typical pill mill.”
Of the doctors, Granade suggested Couch’s practice “had gotten away from him,” and though possibly unintentional it “certainly was illegal.” She called Ruan the more educated of the pair — a better doctor, but one who “could not control his desire to make the most money he could.”
For prosecutors, it was a landmark victory as the first case in U.S. history to see any medical professional successfully tried and convicted of RICO violations. Acting U.S. Attorney Steve Butler called the case “groundbreaking,” saying it could likely have nationwide implications.
“What happened with these two doctors could happen in any other situation,” he said. “However, their conduct in this case, which led to their conviction and these two long sentences, is not indicative of the vast majority of medical professionals or their motivations, and we know that.”
Despite the end of the two-year legal battle, there are still several things factors in the case that have yet to be resolved, in addition to appeals already initiated by both of the defendants.
From the beginning, money has been a focus of the public discourse surrounding the PPSA case. That’s partially due to some of the assets that were seized the day the doctors’ clinics were raided, including Ruan’s multi-million-dollar exotic car collection, which the government has already liquidated.
Granade has also ordered Ruan and Couch to pay $12.5 million and $14 million, respectively, in restitution to a handful of public and private insurance providers, along with an additional $2.7 million in restitution shared by both doctors. Yet, there’s still millions of dollars in assets to be sorted, including more high-end cars, multiple properties and numerous six-digit bank accounts associated with Ruan, Couch and PPSA.
Though a preliminary order of forfeiture has been filed, a litany of intervening parties claiming an interest in those assets has complicated the process. At sentencing, Assistant U.S. Attorney Deborah Griffin said it could be weeks before those matters are resolved.
Some of those parties include former business partners and family members. Others are banks and lenders holding mortgages and leases on some of the assets the government is seeking. One of the more interesting claims, though, was filed by an individual named Lori Carver, who claims to have been the “whistleblower” that initially put PPSA on federal authorities’ radar.
Though prosecutors dispute her influence on their investigation, Carver did file a civil lawsuit two years before Ruan and Couch were indicted that makes several of the same allegations that later became charges in the government’s criminal case.
Carver — a former clinical supervisor at PPSA — claimed in 2013 the doctors were knowingly overbilling Medicare, Medicaid, TRICARE and private insurers in a number of ways, including coding examinations performed by a nurse practitioner to make it appear patients had been seen by a doctor.
Some of Carver’s allegations never arose in their criminal case, including one suggesting PPSA was regularly sanitizing and reusing disposable needles. However, other claims — including routine kickbacks from drug companies and staff members forging prescriptions — became key components of the doctors’ indictment, trial and conviction.
Carver claims she warned Couch in 2011 about an increase in patients questioning why their insurance had been billed for a doctor’s visit when they’d seen a nurse practitioner. Couch allegedly responded by saying, “I don’t give a damn. These people will do whatever I say. They are addicted to their medications, and if they don’t like it, they won’t get their prescriptions.”
According to the lawsuit, Carver had multiple meetings with local prosecutors before her civil suit was halted so the government could begin the investigation that ultimately led to Ruan and Couch’s criminal indictment — the same prosecutors who are downplaying her role in the case.
Now, the government is asking Granade to dismiss a motion Carver filed to intervene in the pending forfeiture actions. In fact, when a relative of a deceased PPSA patient referenced Carver as a “whistleblower” while addressing Granade, prosecutors made an oral objection, saying the “government [disagreed] with statements made about the origins of this case.”
While Griffin says Carver’s civil suit remains “viable and pending,” her attorneys contend the four-year freeze on the case — one the government petitioned for — hampered it from moving forward, and there likely won’t be anything left to collect when the government is finished.
Prior to sentencing, both sides were able to agree Carver could have an “arguable claim” under the False Claims Act to a portion of any restitution awarded to federal insurance programs like Medicare or TRICARE, though at the time there had been no ruling on any restitution amounts.
Now, with restitution figures set in the millions, it’s likely even a small share could be substantial if Carver’s claims are proven in court and her motion to intervene is granted by Granade.