What Happens When a Physician Assistant Faces Prescribing Violations or Criminal Charges in Texas

I’m Pat Ruzzo, and I have been a criminal defense attorney based in Houston, Texas for over thirty-five years. During my career, I have represented numerous physician assistants facing allegations related to prescribing practices and criminal charges. What I have learned is this: physician assistants face unique vulnerabilities because of their prescribing authority and their position in the healthcare system.

Prescribing authority is one of the most valuable aspects of being a physician assistant. It distinguishes you from many other healthcare professionals and makes you valuable to employers. It also makes you a target for heightened scrutiny when anything goes wrong.

Before we discuss what happens when problems arise, you need to understand how prescribing authority works for physician assistants in Texas.

Physician assistants can prescribe medications, including controlled substances, under certain circumstances. This authority is not unlimited. You must have:

A prescriptive authority agreement that is compliant with Board rules. This agreement must be in place between you and your supervising physician.

Biennial renewal of this agreement. You must renew your prescriptive authority agreement every two years when you renew your license.

Compliance with all applicable laws including the Texas Controlled Substances Act, federal DEA regulations, and all Board rules governing prescribing.

Proper supervision by a licensed physician who has agreed to supervise your practice and prescribing.

When any of these elements is compromised, or when allegations arise about your prescribing practices, you face potential criminal charges, Board discipline, or both.

Common Prescribing-Related Issues That Lead to Investigations

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Physician assistants face Board investigations and criminal charges related to prescribing for various reasons:

Prescribing Outside Scope of Practice

Physician assistants must practice within the scope defined by their training, their supervisory agreement, and Board rules. Prescribing medications outside your scope of practice can result in allegations of:

• Practicing medicine without proper authorization
• Violating the terms of your supervisory agreement
• Endangering patients through inappropriate prescribing

Prescribing for Family, Friends, or Yourself

Prescribing controlled substances or other medications for yourself, family members, or friends without establishing a proper physician-patient relationship and conducting appropriate evaluations is prohibited. This is one of the most common prescribing violations I see.

Physician assistants sometimes think they can write prescriptions for family members as a convenience or to save them a doctor’s visit. This is a violation that can result in both criminal charges and Board discipline.

Inappropriate Prescribing of Controlled Substances

Prescribing controlled substances, particularly opiates and benzodiazepines, without proper evaluation, documentation, and monitoring can lead to allegations of:

• Contributing to substance abuse or diversion
• Prescribing outside accepted medical standards
• Failure to properly assess and monitor patients
• Running a “pill mill” operation if the pattern is egregious

Prescription Fraud or Forgery

Writing prescriptions using another provider’s information, forging prescriptions, or creating fraudulent prescriptions is both a criminal offense and grounds for immediate license action.

Record Keeping Failures

Failing to properly document prescribing decisions, patient evaluations, and monitoring can lead to allegations that you cannot substantiate that your prescribing was appropriate.

Loss of Supervising Physician

If your supervising physician terminates the supervisory agreement, you lose your ability to prescribe. Continuing to prescribe after loss of supervision is a serious violation.

Prescribing violations can result in criminal charges:

Illegal Distribution of Controlled Substances

If prosecutors believe you were prescribing controlled substances inappropriately or outside legitimate medical practice, you can be charged with illegal distribution. This can be charged at the state or federal level.

State charges under the Texas Controlled Substances Act can result in:

• Felony charges ranging from state jail felonies to first-degree felonies
• Two to ninety-nine years in prison depending on the amount and circumstances
• Substantial fines

Health Care Fraud

If your prescribing is connected to fraudulent billing to Medicare, Medicaid, or private insurance, you can face health care fraud charges. These are serious felonies that can result in lengthy prison sentences.

Prescription Fraud

Creating or using fraudulent prescriptions is a felony under Texas law. The level of felony depends on the type and amount of medication involved.

Drug Possession

If you are found in possession of controlled substances that you prescribed to yourself or obtained through fraudulent prescriptions, you can be charged with drug possession in addition to the prescribing-related charges.

Board Investigations Related to Prescribing

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Simultaneously with any criminal investigation or charges, the Board will likely pursue its own investigation of your prescribing practices.

Prescribing investigations typically begin when:

A patient complains about receiving inappropriate prescriptions or being denied appropriate care.

A pharmacy reports suspicious prescribing patterns to the Board or law enforcement.

Law enforcement shares information from their investigations of drug diversion or illegal distribution.

Peer review reveals concerns about your prescribing practices during review of your clinical work.

Medical records audits identify patterns of inappropriate prescribing, inadequate documentation, or failure to follow accepted standards.

Your supervising physician reports concerns about your prescribing to the Board.

Insurance companies or government programs flag unusual prescribing patterns during fraud investigations.

When the Board investigates prescribing allegations:

They will request detailed information including:

• All prescribing records for specified time periods
• Patient charts and evaluations
• Documentation of your supervisory agreement
• Records from pharmacies where your prescriptions were filled
• Communications with your supervising physician
• Continuing education records related to prescribing

They will review patterns looking for:

• High volumes of controlled substances prescribed
• Inappropriate combinations of medications
• Inadequate patient evaluations before prescribing
• Prescriptions written for yourself, family, or friends
• Prescribing outside your scope or specialty
• Failure to follow accepted medical standards

They may interview patients, pharmacists, your supervising physician, and other individuals with knowledge of your prescribing practices.

While your case is under investigation or proceeding through the disciplinary process, several things can happen to your prescribing authority:

Voluntary surrender. In some cases, as part of negotiations or to demonstrate cooperation, you might voluntarily surrender your prescribing authority temporarily while the investigation proceeds.

Restrictions imposed as a condition. The Board might restrict your prescribing to certain classes of medications, require additional supervision of prescribing, or impose other limitations as a condition of continued practice.

Complete suspension of prescribing authority. In serious cases, the Board might suspend your prescribing authority entirely while allowing you to maintain your license for non-prescribing practice.

Emergency restrictions. If the Board determines there is an imminent threat to public welfare, they can impose immediate restrictions on your prescribing authority.

Loss of prescribing authority, even temporarily, significantly impacts your ability to work and your value to employers.

Real Case Considerations

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Because prescribing cases often involve complex medical and legal issues, and because the specific circumstances heavily influence outcomes, I will speak generally about these cases.

Successful Defense Strategies

In cases I have advised physician assistants facing prescribing allegations:

Demonstrating appropriate medical judgment.
When prescribing decisions can be supported by proper evaluation, documentation, and accepted medical standards, even if another provider might have made different decisions, successful defense is possible.

Showing compliance with supervision requirements.
Documenting that prescribing was done under proper physician supervision and within the scope of your supervisory agreement helps defend against allegations of unauthorized practice.

Establishing proper patient relationships.
Demonstrating that appropriate physician-patient relationships existed, proper evaluations were conducted, and prescribing was medically justified can defeat allegations of inappropriate prescribing.

Proving lack of criminal intent.
In criminal cases, the government must prove criminal intent. Demonstrating that prescribing was done in good faith belief it was medically appropriate, even if that belief was mistaken, can be critical to criminal defense.

Challenges in These Cases

Prescribing cases present significant challenges:

Expert testimony is often required.
Both sides may present medical experts who disagree about whether prescribing was appropriate. Defending these cases requires resources to retain qualified experts.

Pattern evidence can be damaging.
If prosecutors or the Board can show patterns of inappropriate prescribing over time, it becomes much harder to argue individual prescribing decisions were reasonable mistakes.

Hindsight bias affects review.
When reviewing prescribing after a patient experiences a bad outcome, reviewers tend to judge your decisions more harshly than they would have prospectively.

Prescribing cases often involve both criminal charges and Board discipline simultaneously. This creates complex strategic issues:

Anything you say to the Board can be used criminally. If you provide detailed explanations of your prescribing to the Board, prosecutors can subpoena that information and use it in the criminal case.

Criminal outcomes affect licensing outcomes. Certain criminal convictions related to prescribing trigger automatic or presumptive license sanctions.

The burden of proof is different. You might be acquitted in criminal court based on reasonable doubt, but the Board could still find by preponderance of evidence that you violated prescribing rules.

Timing can be critical. Decisions about which case to address first, how to coordinate responses, and when to negotiate can significantly impact outcomes in both proceedings.

This is why you need an attorney who practices in both criminal defense and professional licensing. Very few attorneys have experience in both areas.

What You Should Do If You Face Prescribing Allegations

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If you are facing allegations related to your prescribing practices or have been arrested for prescribing-related charges:

Stop prescribing immediately or consult with an attorney about what modifications to make to your prescribing practices. Every prescription you write while under investigation can be used as evidence.

Do not talk to investigators without an attorney present. Do not try to explain your medical reasoning or justify your decisions. Exercise your right to remain silent and your right to have an attorney present.

Preserve all records exactly as they exist. Do not alter, destroy, or “clean up” any medical records or prescribing records.

Contact an attorney immediately who has experience in both criminal defense and physician assistant licensing matters. These cases require coordinated strategy across both proceedings.

Do not resign or voluntarily surrender your license or prescribing authority without consulting an attorney about the strategic implications.

Why You Need an Attorney Who Understands Both Criminal Defense and Medical Licensing

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Prescribing cases require an attorney who understands:

Criminal law involving drug offenses. I have defended drug cases for over thirty-five years. I understand how prosecutors build cases involving controlled substances, what defenses are available, and how to negotiate favorable outcomes.

Federal law and DEA regulations. Many prescribing cases involve federal charges or investigations. I understand federal controlled substances law and how it differs from state law.

Physician assistant licensing. I have represented physician assistants before the PA Board and Texas Medical Board. I understand the rules governing prescribing authority, supervisory agreements, and scope of practice.

Medical peer review. I understand the peer review process, confidentiality protections, and how peer review findings can impact licensing cases.

The intersection between criminal and licensing cases. I know how to coordinate strategy to protect you in both proceedings and avoid creating evidence in one that damages you in the other.

This combination of experience is rare but essential for defending prescribing cases.

The High Stakes of Prescribing Cases

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Prescribing cases carry particularly high stakes:

Your freedom is at risk. Prescribing-related criminal charges can result in lengthy federal or state prison sentences.

Your license and career are at risk. Loss of your physician assistant license ends your career in this field.

Your prescribing authority is at risk. Even if you keep your license, loss of prescribing authority severely limits your employment options and earning potential.

Your reputation is at risk. Publicized prescribing violations can destroy your professional reputation even if you ultimately prevail.

Your supervising physician may be implicated. Prescribing issues can create problems for your supervising physician, potentially ending that professional relationship.

The investment in proper legal representation is substantial, but so are the stakes.