Montgomery doctor convicted on 101 counts in pill mill case

Dr. Richard Stehl could face up to life in prison

Montgomery doctor convicted on 101 counts in pill mill case

MONTGOMERY, Ala. (WSFA) - A jury has convicted Montgomery doctor Richard Stehl on all counts including drug distribution, health care fraud, and money laundering. It took about four hours of deliberations to reach their verdict.

The jury considered 101 counts against Stehl: 94 counts of drug distribution for prescribing controlled substances to patients outside the course of professorial medical practice, two counts of health care fraud, four counts of money laundering by concealment, one count of money laundering - promotion.

Jurors heard nearly 12 full days of testimony during the 3-week trial.

Following the jury’s decision, the doctor was immediately remanded into federal custody until sentencing in April. He faces up to life in prison.

Defense, prosecution react to Dr. Stehl's guilty verdict

During the trial, the government worked to show Stehl was running a health care fraud scheme out of his office by writing prescriptions to patients for substances they didn’t need while requiring them to return monthly for refills and unnecessary injections.

In turn, prosecutors said Stehl overbilled Medicare and Blue Cross Blue Shield for moderately complex office visits that held a higher reimbursement rate. The government also called witnesses who testified that Stehl took those reimbursements, which they called “dirty money” gained through criminal activity, and laundered it through a holding company, or Limited Liability Corporation, to private accounts in an effort to conceal who owned the funds. They also contend that Stehl paid a psychiatrist $1,000 to backdate reports for the Alabama Board of Medical Examiners in order to keep his license with those funds, accounting for a single count of money laundering by promotion.

Stehl’s defense team worked to show he was practicing good medicine and was also treating illnesses with prescriptions that weren’t controlled substances. During closing arguments, the defense told the jury they must decide whether Stehl was practicing medicine or whether he was a drug dealer, suggesting the evidence showed he was acting as a physician while seeing the patients in question.

During the trial the jury heard from multiple patients. One testified that Stehl’s prescribing habits and unnecessary injections landed her in the hospital and created dependency issues. Another patient testified that she relied on Stehl to fuel her pill problem, stating she would give in to his sexual advances in order to get her refills.

Patients said Stehl didn’t conduct routine examinations, which spoke to the charges for the health care fraud scheme. A former employee testified that Stehl saw upwards of 70 patients a day, rarely wore a stethoscope and scrubs, and often never had the patients sit on the exam table, which didn’t meet the criteria for billing for a 25-minute office visit which involved a detailed exam and an issue of moderate medical complexity.

Stehl testified in his own defense and was on the stand for nearly three full days. A defense attorney walked him through nearly every prescription in the indictment and he told the jury why he wrote those prescriptions.

The government cross-examined Stehl for nearly two days, hammering home the lack of information in his patient records and whether it justified writing multiple prescriptions for controlled substances for multiple patients. The government asked whether he could bring someone in, write a prescription and never put it in the records, and Stehl responded yes.

“If you didn’t write it down, did it ever happen?” asked Assistant United States Attorney Jonathan Ross. Stehl disagreed. Ross asked Stehl whether any of his records were legitimate, questioning whether anything that’s noted ever happened - as many of the records had the same issues circled. Stehl again disagreed.

“You picked the problems on the page to justify the prescriptions didn’t you,” Ross asked. Stehl said that was incorrect. “Why did you write down that all the exams were normal but then write multiple prescriptions for controlled substances?” Ross questioned.

The government specifically asked Stehl why he prescribed five controlled substances, which included three benzodiazepines, to a 73-year-old woman. Stehl responded, “she knew how to take her medication.” When asked if it was troubling that he could have put her at risk of respiratory depression, which can be fatal, Stehl responded, “I was concerned, but it was not troubling.” When the government asked Stehl if the only thing he saw wrong with the file was the poor handwriting, he agreed.

The government also questioned him about why he prescribed phentermine, a stimulant appetite suppressant, to a patient who wasn’t clinically overweight or obese. The patient’s blood pressure was recorded as 169/103. The government asked Stehl whether he attributed the high blood pressure to the medication, and he said no. “She could have died,” stated Ross. “I don’t know about that,” Stehl said, arguing the medical technician often recorded the wrong blood pressure due to putting the cuff over the patients’ clothes.

They also asked Stehl why he continued to prescribe controlled substances to a patient he knew was doctor shopping and addicted to pain medication. Stehl responded that he was planning to taper her off the medication. The government then asked him to find any indication of that in her chart, but he couldn’t. When asked whether seeing four other doctors for controlled substances in the same month was doctor shopping, Stehl answered no. The government noted Stehl wrote in the patient’s chart, “discussed subpoena.”

Stehl couldn’t say why he had to discuss his recent subpoena for medical records with the patient. When asked if he wrote other notes in the records before sending them to the ABME, Stehl said yes, but couldn’t remember what he wrote or how many records he wrote in. Ross again asked, “You think the only thing you did wrong was use bad handwriting?” Stehl said, “Generally, yes”.

During the lengthy cross-examination, the government linked Stehl to Dr. Gilberto Sanchez, who is in federal prison for his involvement in a pill mill health care scheme. Stehl leased office space from Sanchez for a short time.

The government asked Stehl why his prescribing habits changed, requiring patients to come back for monthly visits like Sanchez. They also showed Stehl’s internet searches for stories about Sanchez, Sanchez’s property and the selling of his house after Sanchez was convicted. The records also showed texts to other people about Sanchez’s arrest, texting that he was led out of his office in handcuffs. The government asked Stehl whether he was worried about Sanchez telling the DEA about him, which he denied.

“Did you change how you practiced after his arrest?” Ross asked Stehl. He said yes, stating he tested patients for drugs. “Sanchez’s arrest didn’t make it any more or less likely your patients used recreational drugs,” Ross questioned. Stehl responded - no. “But it was worth your time and money then [after Sanchez’s arrest],” Ross asked. “Yes”, said Stehl.

The government launched its investigation after law enforcement received an anonymous call that Stehl was over-prescribing controlled substances to the caller's sister, and refused to stop despite their family's plea to the doctor.

“The caller then said that Stehl had given [the patient] his cellular telephone number and told [the patient] to ‘call if [she] needed a refill’,” the complaint cited.

According to the Alabama Prescription Drug Monitoring Program, or PDMP, which tracks every controlled substance filled in Alabama, including the patient’s name, the prescriber, and date and location where it was filled. Stehl’s PDMP report showed “extensive and alarming" prescribing habits, according to court documents, ranking Stelh’s prescription rate 116 of 12,843 providers in Alabama in 2018.

That ranking put Stehl in the top 0.9 percent of all prescribers, according to the court record.

Stehl maintained his innocence following his arrest. His defense team said they would determine whether to appeal after the sentencing.

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