More than a decade ago, Florida legislators passed laws to regulate so-called pill mills that once dominated the state 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's oversight.
In early June, federal prosecutors accused Dr. Sergei Margulian, 58, of Hallandale Beach, of doling out oxycodone to clients he never examined, 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 — filled repeatedly to the same individuals. The end goal was "to generate and conceal large profits," according to indictments.
One pharmacist has pleaded guilty and surrendered her medical license, while the others have pleaded not guilty.
WLRN set out to understand how the accused doctor, pharmacists and recruiters sold millions of pills illegally for at least three years, without the state's 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 WLRN show that inspections by health department pharmacists in 2023 and 2024 reported no issues at Margulian's clinics: Sunrise Healing Health Center, in a Davie strip mall, and Healing Health Center, across from a high school in Hialeah.
That's despite the Department of Justice alleging, during that same period, the doctor was prescribing opioids to recruited clients "without regard to medical need." The agency declined to comment for this story.
" If you have four walls, a roof and clean equipment, basically you're halfway there," 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's prescribing patterns, she said.
The second law — the database — collects key information on patients who are prescribed opioids, but the Florida Legislature designed the system to be "passive," 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.
"They 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," Aronberg said.
The health department did not respond directly to a list of questions, nor requests to interview the director of its Prescription Drug Monitoring Program (PDMP), but the agency provided a statement.
The goal of the drug monitoring program is to "provide the information maintained in the system to health care practitioners to augment their clinical decision making," health department spokeswoman Isabel Kilman wrote.
"The PDMP does not have regulatory authority over licensees, and they do not conduct investigations into possible violations," Kilman wrote.
Meanwhile, Margulian and Olushola Yusuf, a Tampa pharmacist accused of participating in the scheme, have been released 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's release with the federal court, he was mandated to surrender his medical license. Yusuf was restricted from working in pharmacies.
No disciplinary actions show on the state's records of Margulian or Yusuf.
Margulian declined to comment when reached by WLRN. Yusuf and her public defender did not respond to requests for comment.
The Florida Board of Medicine directs all press inquiries to the health department, which said it could not comment "on any possible cases until 10 days" after the board finds probable cause for discipline.
Pill mills' 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 investigations by media news outlets, grand juries and law enforcement authorities.
Between August 2008 and November 2009, a new pain clinic opened in Broward and Palm Beach counties every three days on average, a Broward County grand jury found. Four out of every 10 oxycodone pills (30 milligrams) in the U.S. were sold in Florida in 2009-10, according to The Palm Beach Post. The federal 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 the PDMP, administered by the health department. The program requires doctors to log whom they prescribe opioids to and review their patients' records beforehand. The measure became law in 2009 but wasn't 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.
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 report.
"We've gone from being known as the 'oxy express' to being a role model for our sister states," a former commissioner of the Florida Division of Law Enforcement told Reuters in 2012.
Former Florida Attorney General Pam Bondi, who now serves as U.S. Attorney General, includes the PDMP and subsequent prosecutions of pill mills as signature achievements on her federal biography page.
Some studies associated the implementation of the PDMP and pill mill law to less "at-risk patients" using opioids in Florida.
The alleged 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 federal court documents related to Kurian's guilty plea.
For years, cash-paying customers and out-of-state patients received the same "factory-like" 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.
"One customer routinely visited Chans to fill prescriptions for several individuals for large quantities of oxycodone 30mg, paying approximately $800 in cash per bottle," the plea document stated.
Kurian told her boss, Yusuf, of the red flags but was instructed to continue dispensing.
In October 2024, Kurian pleaded guilty to one felony count of conspiracy to distribute and dispense a controlled substance.
"These 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," Jude Faccidomo, Kurian's Miami-based attorney, told WLRN in a statement.
"What is important is she knows she should have known better and that is why she immediately accepted responsibility and (pleaded) guilty," he wrote.
A date for sentencing has not been set. That same month, Kurian surrendered her license to the Board of Pharmacy and promised never to apply as a pharmacist again in Florida.
Feds go after pill mills
Eight months after Kurian's guilty plea, federal prosecutors went after other medical providers and alleged co-conspirators.
Yusuf, 59, 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, the indictment said.
Between 2021 and 2024, Yusuf, Gimenez and Kurian dispensed around 335,000 pills of oxycodone from the two Broward County pharmacies, according to the indictment.
Yusuf and Gimenez have pleaded not guilty. A lawyer for Gimenez did not respond to a request for comment. In a court filing, Yusuf invoked her Fifth Amendment right 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 "lists that contained patients' names, dates of birth, and the number of pills of oxycodone to prescribe to them," 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's case is linked with overlapping facts and witnesses.
Margulian and Mendez 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 WLRN he was working when police raided Margulian's 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 health department wrote "Yes" 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.
"(Inspectors are) not evaluating the viability of the information," she said.
McElhaney, who served as a Broward County sheriff's 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't 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.
" Even 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," McElhaney said.
They have to be subpoenaed and the records have to show "a pattern of what would not be any type of legitimate prescribing," 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 it learned about his alleged conduct.
Prescriptions assigned by Margulian and filled by the Broward pharmacies might have been caught earlier if the state's PDMP was more "active," according to Aronberg, the former state attorney.
States like North Carolina, Kansas, Wyoming and Texas all have systems within their drug monitoring programs to proactively flag law enforcement or medical boards when irregularities arise.
" The state regulators should have some ability to see that there's a scam going on under their noses," said Aronberg.
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