MONTGOMERY, AL (WSFA) - It's been one year since Montgomery physician Gilberto Sanchez was indicted for operating an alleged pill mill out of his office on Atlanta Highway. During that course of time, the investigation expanded in ways few could anticipate.
To date, more than a dozen Family Practice employees, including two other doctors, three nurse practitioners, a counselor, and others administrators have been indicted.
Most recently, an outgoing state representative, Ed Henry, was indicted for his alleged involvement in running a healthcare scheme out of Sanchez's practice.
Behind the brick facade at Family Practice, prosecutors say Sanchez was operating various health care and money laundering schemes, leasing his private property to patients, and even selling cars in the parking lot.
Assistant United States Attorney Jonathan Ross, who is leading this prosecution, explained Sanchez was also running an addiction treatment center out of his practice.
"He was not only getting people hooked on controlled substances, he was getting them off the controlled substances," Ross stated. "It's the equivalent of a bartender running the AA meetings. That's what was going on there."
Court documents indicate Sanchez used healthcare reimbursement claims to private insurance, Medicare, and Medicaid to become profitable, requiring patients prescribed opioids to make monthly visits, undergo a battery of unnecessary tests, and double billing for what Sanchez described as a required monthly counseling visit.
"He hired a counselor, who has also since been indicted," explained Ross. "Sanchez informed patients if you are receiving controlled substances, you have to see the counselor and undergo mental health counseling while you are receiving the medication - saying this was a new rule the DEA was imposing. There was never such a rule by the DEA. The counselor was purely a money-making venture for Sanchez."
It took months and interagency resources to use the practice's medical records to reconstruct billing schemes and bring the subsequent indictments.
Four case agents were assigned to the investigation due to the sheer volume of evidence.
"The day of the search warrant, the DEA pulled away with a U-haul truck's worth of paper," said Ross. "Sanchez's record keeping was not stellar, that's difficult when you have to dig through the paperwork to see where the fraud is hidden. It's concealed through scattered record keeping."
Ross also believes those records show Sanchez was providing proper care for patients during his early years at Family Practice.
"I think he did so up until the time he got indicted," Ross said. "The problem though, Sanchez started down that slippery slope by writing one unnecessary prescription, the next month writing another refill, then doing it for another patient. Over time, what was a legitimate medical practice devolved into a place for people to come and get controlled substances and narcotics."
During the time Sanchez's alleged pill mill was in operation, it was a lucrative business.
"In 2014, the practice earned gross receipts of or about $4,352,352.63," Sanchez's indictment cited. "In 2015, the practice earned gross receipts of or about $3,292.549.40. In 2016, the practice earned gross receipts of or about $3,087,530.25."
Following his arrest, the practice encountered financial turmoil. Testimony revealed payroll checks were bouncing from the business accounts. That's when the prosecution learned Sanchez went around court orders and became involved with operations.
"When we found out he was continuing to go to the practice and sending handwritten notes to other practitioners asking they order various ultrasounds and other tests, we became concerned," Ross said of Sanchez's actions. "It appeared he was continuing to practice medicine and participate in health care fraud. The judge found Sanchez was practicing medicine without a license. He was placed on house arrest with electronic monitoring."
One year later, it's still difficult to measure the true scope of this case. Ross couldn't disclose the number of victims but stated Sanchez had about 9,000 patients, many of whom were on controlled substances.
Privacy concerns also prohibit the government from disclosing the number of victims who developed subsequent illness or death as a result of the reported prescribing habits at Family Practice.
"I can't comment on specific patient outcomes, particularly those we haven't charged," Ross explained. "However, I can tell you anytime a doctor is writing dangerous quantities and combinations of controlled substances as Sanchez was doing here, there's a risk the patient can be harmed, can overdose, and that could lead to death. I will leave it to those who are affected by Sanchez's prescribing habits to tell their stories."
There's no word if more indictments are forthcoming in this case.