Sometimes trusted professionals fuel opioid epidemic

While authorities investigate where Prince obtained the drugs that killed him, as well as the scandal that's rocked the University of Minnesota wrestling team, a small scene reflecting the country's growing opioid problem played out in an almost-empty federal courtroom Monday with a pharmacist as the unlikely protagonist.

Boris Leo Rabichev, 58, stood before Judge Ann Montgomery in U.S. District Court in Minneapolis, his business ruined and his freedom on the line, and pleaded for leniency.

"I am sorry and I accept all responsibility," Rabichev said quietly. "When this started, it was much simpler. It wasn't my goal" to get involved in a drug conspiracy. "It comes out of the dark to me."

Montgomery acknowledged that Rabichev's crime was complicated and sophisticated, but that he also quickly admitted the scheme and helped authorities prosecute two others. "I'm bothered [that this] is not just a single moment of bad judgment," Montgomery said. "It's a very serious crime."

Rabichev, then manager and part owner of Best Aid Pharmacy, acknowledged working with Bloomington pharmacist and physician Elena Lev Polukhin in a conspiracy that provided "unwarranted prescriptions for pain cream and prescribed opioids without any legitimate medical purpose" from at least 2011 to December 2014. Rabichev also admitted to conspiracy to defraud the U.S. government and to paying Polukhin kickbacks for patients she directed to his store for narcotic pain creams.

On the pharmacy's website, Rabichev advertised high safety controls over his products: "At Best Aid Pharmacy we maintain extremely rigorous standards in patient safety."

Instead, Rabichev said his drugstore bought bulk powders of the cream ingredients and mixed, or compounded, them himself. The store sold the creams to Polukhin's patients, many of whom may not have had any medical need for the drugs. Best Aid then submitted claims for reimbursement to Medicare and Medicaid that falsely said the pain creams were made using tablet, capsule or liquid forms of the various ingredients, greatly inflating the reimbursement amounts. Rabichev paid Polukhin more than $40,000 in kickbacks, funneled through a charitable trust she ran.

In March, the Centers for Disease Control and Prevention called the opioid problem across the U.S. "doctor-driven," and recommended that physicians find alternative methods to ease pain. But there will always be those who seek loopholes in order to profit, regardless of the effect on the customer, authorities say.

Polukhin pleaded guilty to violating the anti-kickback statute, according to a spokesman for the U.S. attorney's office in Minneapolis. Her sentencing is pending.

Several local and federal agencies put considerable time into this case, even though penalties are often minimal. But health care fraud, particularly surrounding prescription drugs, Medicare Part D, is a growing national problem.

On Monday, Judge Montgomery was also disturbed that the scheme involved defrauding the government. "The health care system is something people are very skeptical about," she said. They think "there's got to be some fraud or corruption to drive these prices up so much."

Rabichev's attorney, Allan Caplan, argued that mitigating factors in his client's case included immediate acceptance of responsibility, and he called Rabichev's cooperation a "tipping point" for the government case. "I'm not suggesting Mr. Rabichev warrants the Medal of Honor," Caplan said. But "his clients got what they thought they were getting. He's lost his business; he's lost a great deal."

So have his customers, no doubt.

"Physicians and pharmacists are entrusted to make decisions that are medically necessary and that are in the best interest of their patients, not for their own personal financial gain," said Lamont Pugh III, special agent in charge, Chicago region, U.S. Department of Health and Human Services, at the time of the indictments.

After an hour of discussion, Montgomery sentenced Rabichev to 18 months in a federal facility and ordered him to repay more than $621,000 in illegal gains — another moment, writ small, in America's opioid epidemic.

jtevlin@startribune.com • 612-673-1702