A Maine doctor facing federal charges had the highest opioid prescribing rate in Maine and several of her patients died of overdoses within 45 days of getting a prescription from her, an FBI agent states in a newly unsealed affidavit.

Until her indictment in October, Dr. Merideth Norris ran Graceful Recovery, an addiction treatment center in Kennebunk, and she is a well-known addiction treatment counselor in Maine.

She is now charged with 10 counts of illegal distribution of opioids and other controlled substances, but the federal government believes Norris was involved in much more than that, according to an affidavit filed last October by FBI special agent Dale Wengler, which outlined a number of “red flags” in Norris’ patient records – she prescribed dangerously high doses of opioids, ignored urine test results that showed patients continued to use illicit drugs, and performed unnecessary tests and then wrongfully billed Medicare and Medicaid.

Warner wrote that he believed Norris also committed health care fraud and violated federal anti-bribery statutes by allowing a drug testing lab that she often used to test patients’ urine samples to pay for a full-time employee in her office.

Norris is the first person to be charged by an opioid prescription task force created in June to scrutinize physicians, pharmacists and medical professionals. The task force has not announced charges against any other Maine doctors.

Court filings suggest Norris faces a long road to trial with “thousands of scanned files” to review, many of which are confidential, lengthy medical files. Norris’ attorneys, Amy Fairfield and Timothy Zerillo, did not respond to multiple requests from the Portland Press Herald on Friday asking about the new allegations, but have previously denied the pending charges.

OVERPRESCRIBING

Norris’ charges were announced last fall as the U.S. Centers for Disease Control and Prevention publicly weighed new guidance on whether to ease back on currently strict guidelines for prescribing addictive painkillers. Norris was an outspoken critic of Maine’s efforts to limit opioid prescribing, asking lawmakers in 2016 to trust doctors.

But Wengler said Norris was enabling addiction in some of her patients by continuing to prescribe them dangerously high doses.

Nationally, the CDC says patients should not be prescribed more than 9o MME – a metric that officials use to measure a patient’s daily dosage of opioids.

But Norris often prescribed more than three times that amount. In the most extreme examples, one patient reached 1,200, and another at least 1,500 MME, putting patients at “imminent risk for an overdose,” according to a pharmacy professor at Ohio State University, Donald Sullivan, who reviewed Norris’ records for the FBI.

She was also prescribing high doses of benzodiazepines, another controlled substance that when taken with opioids increases the risk of overdose, Wengler said.

One of the earliest alarms sounded in November 2021 when Walmart refused to fill any prescriptions she wrote.

The company said her patients appeared to be “pharmacy shopping,” using multiple pharmacies to fill their prescriptions. They insisted on paying in cash, according to the affidavit, and their prescriptions called for an “unusually large quantity or high starting dose.”

Walmart flagged its concerns to the Maine Board of Osteopathic Licensure. By June 2022, the board had reviewed records and found three patients who were on high doses of methadone, a drug that’s prescribed to treat opioid addictions, without any plan to taper those medications.

As of her October arrest, the board had dismissed the case, but pledged to reopen its investigation.

She was still licensed to practice, according to the board’s website on Friday, although she is barred from prescribing any controlled substances while awaiting trial.

KICKBACK VIOLATIONS 

While the affidavit doesn’t levy additional charges against Norris, investigators said she also violated federal kickback laws by allowing Millennium Health, the company she used to perform routine drug testing, to fund a full-time position in her office.

Norris sent more than 1,300 samples from 154 patients to Millennium’s California lab from January 2018 to June 2022, according to court documents. Millennium filed more than $604,000 in claims to Medicare, and Medicare paid the company approximately $263,000.

Norris also sent Millennium more than 4,200 urine samples under MaineCare and the company submitted more than $962,000 in claims, and was paid nearly $264,000.

An unnamed former employee at Graceful Recovery told the FBI that Millennium “embedded” someone at Norris’ office to collect urine samples, according to the affidavit. If Millennium was paying the salary, Wengler wrote, it would violate anti-kickback laws.

Wengler wrote he had probable cause to show Millennium was paying for this position but didn’t state what that proof was.

Millennium said in a statement Friday it was possible there was a Laboratory Service Assistant in Kennebunk to collect samples solely for Millennium, but that person would not have been allowed to perform any other work for Norris’ office.

“We have no reason to believe that a Laboratory Service Assistant stationed at Dr. Norris’s account was performing any tasks beyond those permitted by federal law and OIG guidance, or any tasks other than those directly related to Millennium Health’s services,” general counsel Brian Fowler wrote in an email to the Press Herald.

Fowler said the FBI has not reached out to them about the allegations.

The affidavit also claims that Norris “routinely ignored the results of these tests.”

In one case, a patient tested positive for cocaine, unprescribed Xanax and marijuana, but Norris continued to issue routine prescriptions for hydromorphone, diazepam and methadone.

Another expert, Dr. Shonali Saha, also noted several alarming cases in which patients’ files contained limited information.

Saha said she was surprised one patient – a 74-year-old woman who weighed only 121 pounds and was prescribed 80mg of extended-release Oxycontin, as well as a muscle relaxer and Ambien – “is still alive.”

Another patient was receiving at least 1,280 MME per day (more than 12 times the CDC recommendation) but was also diagnosed with Hepatitis C, which limits liver function and meant the dosage was actually much higher. They also tested positive for cocaine use, but Norris didn’t address it in the file.

All of this, Saha noted, did not have a legitimate medical purpose.