Florida and Tennessee Pain Clinic Owner Extradited from Italy to the United States to Face RICO Charges

A dual U.S.-Italian national was extradited from Italy to the United States on Nov. 20.  The U.S. Marshals Service effectuated the transportation of the defendant from Lamezia Terme, Calabria to Knoxville, Tennessee. 

Luigi Palma, 54, is a co-defendant of Sylvia Hofstetter, who, along with three medical providers, was convicted of numerous charges related to “pill mill” operations in Florida and Tennessee following a four-month trial earlier this year in Knoxville.  Palma contested his extradition from Italy for approximately two years.  The charges against Palma are varied, and reflect his alleged role in owning and operating pain clinics in South Florida and the Knoxville area over the course of several years.   Included in those charges are a Racketeer Influenced and Corrupt Organization (RICO) conspiracy and a conspiracy to distribute oxycodone, oxymorphone, and morphine outside the scope of professional practice and not for a legitimate medical purpose.

Palma appeared before U.S. Magistrate Judge Debra C. Poplin in the Eastern District of Tennessee earlier today and entered a not-guilty plea to all charges.  Palma waived his immediate right to a detention hearing and remains in the custody of the U.S. Marshals Service.  Trial has been set for March 30, 2021, before U.S. District Judge Thomas A. Varlan. 

This sweeping prosecution, which has resulted in approximately 140 convictions so far, is the result of an investigation by the U.S. Attorney’s Office for the Eastern District of Tennessee, the Criminal Division’s Organized Crime and Gang Section, and the FBI High Intensity Drug Trafficking Area, comprised of investigators assigned to the task force by the Loudon County Sheriff’s Office, Knoxville Police Department, Blount County Sheriff’s Office, Roane County Sheriff’s Office, Harriman Police Department, and Clinton Police Department. 

Other agencies provided invaluable assistance, including the Rome Attaché of the Justice Department’s Office of International Affairs; FBI’s liaison in Rome; FBI’s Miami Field Office; the Hollywood, Florida, Police Department; the U.S. Department of Health and Human Services; the Tennessee Department of Health; and the U.S. Drug Enforcement Administration’s Knoxville Diversion Group.  The Justice Department’s Office of International Affairs and FBI’s liaison in Rome were particularly instrumental in effectuating Palma’s extradition, as were Italian law enforcement agencies and prosecutors, including the Italian Ministry of Justice, Carabinieri Raggruppamento Operativo Speciale (ROS), and Interpol-Rome.  The United States is particularly appreciative of their assistance.

The extradition of Palma was made possible by provisions of a treaty between the United States and Italy.  The United States is grateful to the Italian authorities for their robust cooperation in this matter.

An indictment is merely an accusation.  A defendant is presumed innocent until proven guilty beyond a reasonable doubt in a court of law.

Assistant U.S. Attorney Tracy L. Stone and Deputy Chief Attorney Kelly Pearson and Trial Attorney Damare Theriot of the Criminal Division’s Organized Crime and Gang Section represent the United States in the prosecution of this case.

The year 2020 marks the 150th anniversary of the Department of Justice.  Learn more about the history of our agency at www.Justice.gov/Celebrating150Years.

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    The Indian Health Service's (IHS) policies related to provider misconduct and substandard performance outline several key aspects of oversight, such as protecting children against sexual abuse by providers, ethical and professional conduct, and processes for managing an alleged case of misconduct. Although the Department of Health and Human Services (HHS) or IHS headquarters have established most of these policies, area offices that are responsible for overseeing facility operations and facilities, such as hospitals, may develop and issue their own policies as long as they are consistent with headquarters' policies, according to officials. Although some oversight activities are performed at IHS headquarters, IHS has delegated primary responsibility for oversight of provider misconduct and substandard performance to the area offices. However, GAO found some inconsistencies in oversight activities across IHS areas and facilities. For example, Although all nine area offices require that new supervisors attend mandatory supervisory training, most area offices provided additional trainings related to provider misconduct and substandard performance. The content of these additional trainings varied across area offices. For example, three area offices offered training on conducting investigations of alleged misconduct, while other area offices did not. Officials from IHS headquarters told GAO they do not systematically review trainings developed by the areas to ensure they are consistent with policy or IHS-wide training. Facility governing boards—made up of IHS area office officials, including the Area Director, and facility officials, such as the Chief Executive Officer—are responsible for overseeing each facility's quality of and access to care. They generally review information related to provider misconduct and substandard performance. However, there is no standard format used by governing boards to document their review, making it difficult to determine the extent this oversight is consistently conducted. In some cases, there was no documentation by governing boards of a discussion about provider misconduct or substandard performance. For example, none of the seven governing board meeting minutes provided from one area office documented their discussion of patient complaints. In other cases, there was detailed documentation of the governing board's review. Additionally, governing boards did not always clearly document how or why an oversight decision, such as whether to grant privileges to a provider, had been made based on their review of available information. These inconsistencies in IHS's oversight activities could limit the agency's efforts to oversee provider misconduct and substandard performance. For example, by not reviewing trainings developed by area offices, IHS headquarters may also be unable to identify gaps in staff knowledge or best practices that could be applied across area offices. Addressing these inconsistencies would better position the agency to effectively protect patients from abuse and harm resulting from provider misconduct or substandard performance. IHS provides care to American Indians and Alaska Natives (AI/AN) through a system of federally and tribally operated facilities. Recent cases of alleged and confirmed misconduct and substandard performance by IHS employees have raised questions about protecting the AI/AN population from abuse and harm. For example, in February 2020, a former IHS pediatrician was sentenced to five consecutive lifetime terms for multiple sex offenses against children. Several studies have been initiated or completed in response, and IHS has reported efforts to enhance safe and quality care for its patients. GAO was asked to review IHS oversight of misconduct and substandard performance. This report (1) describes IHS policies related to provider misconduct and substandard performance and (2) assesses IHS oversight of provider misconduct and substandard performance. GAO reviewed policies and documents, including minutes from 80 governing board meetings from January 2018 to December 2019. GAO also interviewed IHS officials from headquarters, all nine area offices with two or more federally operated facilities, and two federally operated facilities. GAO is making three recommendations, including that IHS should establish a process to review area office trainings as well as establish a standard approach for documenting governing board review of information. HHS concurred with these recommendations. For more information, contact Jessica Farb at (202) 512-7114 or farbj@gao.gov.
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    A former investment manager was charged in an indictment unsealed today for his alleged participation in a scheme to defraud a North Carolina-based life insurance company out of over $34 million.
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    In Crime News
    A U.S. accountant was sentenced in the Southern District of New York to 39 months in prison for wire fraud, tax fraud, money laundering, aggravated identity theft, and other charges, announced Acting Assistant Attorney General Brian C. Rabbitt and Acting U.S. Attorney Audrey Strauss of the Southern District of New York.
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  • Seven Charged in Connection with a COVID-Relief Fraud Scheme Involving more than 80 Fraudulent Loan Applications Worth Approximately $16 Million
    In Crime News
    Seven individuals across two states were charged in an indictment unsealed today for their alleged participation in a scheme to obtain approximately $16 million in forgivable Paycheck Protection Program (PPP) loans guaranteed by the Small Business Administration (SBA) under the Coronavirus Aid, Relief, and Economic Security (CARES) Act.
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    Two biofuel company owners were sentenced to prison for conspiracy and making false statements to the U.S. Environmental Protection Agency (EPA) and conspiracy to defraud the IRS and preparing a false tax claim.
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  • Data Security: Recent K-12 Data Breaches Show That Students Are Vulnerable to Harm
    In U.S GAO News
    A cybersecurity incident is an event that actually or potentially jeopardizes a system or the information it holds. According to GAO's analysis of K-12 Cybersecurity Resource Center (CRC) data from July 2016 to May 2020, thousands of K-12 students were affected by 99 reported data breaches, one type of cybersecurity incident in which data are compromised. Students' academic records, including assessment scores and special education records, were the most commonly compromised type of information (58 breaches). Records containing students' personally identifiable information (PII), such as Social Security numbers, were the second most commonly compromised type of information (36 breaches). Financial and cybersecurity experts say some PII can be sold on the black market and can cause students significant financial harm. Breaches were either accidental or intentional, although sometimes the intent was unknown, with school staff, students, and cybercriminals among those responsible (see figure). Staff were responsible for most of the accidental breaches (21 of 25), and students were responsible for most of the intentional breaches (27 of 52), most frequently to change grades. Reports of breaches by cybercriminals were rare but included attempts to steal PII. Although the number of students affected by a breach was not always available, examples show that thousands of students have had their data compromised in a single breach. Responsible Actor and Intent of Reported K-12 Student Data Breaches, July 1, 2016-May 5, 2020 Notes: The actor or the intent may not be discernible in public reports. For this analysis, a cybercriminal is defined as an actor external to the school district who breaches a data system for malicious reasons. Of the 287 school districts affected by reported student data breaches, larger, wealthier, and suburban school districts were disproportionately represented, according to GAO's analysis. Cybersecurity experts GAO spoke with said one explanation for this is that some of these districts may use more technology in schools, which could create more opportunities for breaches to occur. When a student's personal information is disclosed, it can lead to physical, emotional, and financial harm. Organizations are vulnerable to data security risks, including over 17,000 public school districts and approximately 98,000 public schools. As schools and districts increasingly rely on complex information technology systems for teaching, learning, and operating, they are collecting more student data electronically that can put a student's information, including PII, at risk of disclosure. The closure of schools and the sudden transition to distance learning across the country due to the Coronavirus Disease 2019 (COVID-19) pandemic also heightened attention on K-12 cybersecurity. GAO was asked to review the security of K-12 students' data. This report examines (1) what is known about recently reported K-12 cybersecurity incidents that compromised student data, and (2) the characteristics of school districts that experienced these incidents. GAO analyzed data from July 1, 2016 to May 5, 2020 from CRC (the most complete source of information on K-12 data breaches). CRC is a non-federal resource sponsored by an educational technology organization that has tracked reported K-12 cybersecurity incidents since 2016. GAO also analyzed 2016-2019 Department of Education data on school district characteristics (the most recent available), and interviewed experts knowledgeable about cybersecurity. We incorporated technical comments from the agencies as appropriate. For more information, contact Jacqueline M. Nowicki at (617) 788-0580 or nowickij@gao.gov.
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    In U.S Courts
    Through a combination of advance planning, expanded use of technology, and the dedication of thousands of employees, the federal Judiciary’s response to the pandemic has enabled courts to continue to operate, while ensuring the health and safety of the public and court personnel, U.S. Senior District Judge David G. Campbell told Congress on Thursday.
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  • Aircraft Noise: Better Information Sharing Could Improve Responses to Washington, D.C. Area Helicopter Noise Concerns
    In U.S GAO News
    According to Federal Aviation Administration (FAA) data for 2017 through 2019, over 50 helicopter operators conducted approximately 88,000 helicopter flights within 30 miles of Ronald Reagan Washington National Airport (D.C. area), though limited data on noise from these flights exist. According to operators, these flights supported various missions (see table below). While the number of flights has decreased slightly over the 3 years reviewed, it is unknown whether there has been a change in helicopter noise in the area. For example, most stakeholders do not collect noise data, and existing studies of helicopter noise in the area are limited. D.C. area airspace constraints—such as lower maximum altitudes near urban areas—combined with proximity to frequently traveled helicopter routes and operational factors may affect the noise heard by residents. Federal Aviation Administration (FAA)-Reported Helicopter Flights Conducted in the Washington, D.C. Area by Operator Mission, 2017–2019 Operator mission Number of flights Military 32,890 (37.4 percent) Air medical 18,322 (20.9 percent) Other aviation activity 13,977 (15.9 percent)a State and local law enforcement 12,861 (14.6 percent) Federal law enforcement and emergency support 5,497 (6.3 percent) News 4,298 (4.9 percent) Source: GAO analysis of FAA data. | GAO-21-200 Note: In this table, we refer to the Washington, D.C. area as including the area within 30 miles of Ronald Reagan Washington National Airport. aIncludes 666 flights for which FAA could not identify an operator or mission based on available historical records. FAA and operators reported taking steps to address public concerns about helicopter noise in the D.C. area. FAA receives and responds to complaints on helicopter noise from the public through its Noise Ombudsman and has recently developed online forms that improve FAA's ability to identify and respond to helicopter noise issues. Operators reported using FAA-recommended practices, such as flying at maximum altitudes and limiting night flights, to address helicopter noise in the D.C. area, but such practices are likely not feasible for operators with military, law enforcement, or air medical evacuation missions. FAA's and operators' approach to addressing these issues in the D.C. area is impeded because they do not consistently or fully share the information needed to do so. According to nearly all the operators we interviewed, FAA has not communicated with operators about helicopter noise or forwarded complaints to them. Similarly, operators often receive noise complaints from the public—some complaints are not directed to the correct operator—but do not typically share these complaints with FAA. As a result, operators have not consistently responded to residents' inquiries about helicopter noise and activity. By developing a mechanism for FAA and operators to share information, FAA could help improve responses to individual helicopter noise concerns and determine what additional strategies, if any, are needed to further address helicopter noise. Helicopter noise can potentially expose members of the public to a variety of negative effects, ranging from annoyance to more serious medical issues. FAA is responsible for managing navigable U.S. airspace and regulating noise from civil helicopter operations. Residents of the D.C. area have raised concerns about the number of helicopter flights and the resulting noise. GAO was asked to review issues related to helicopter flights and noise within the D.C. area. Among its objectives, this report examines: (1) what is known about helicopter flights and noise from flights in the D.C. area, and (2) the extent to which FAA and helicopter operators have taken action to address helicopter noise in the D.C. area. GAO reviewed statutes, regulations, policies, and documents on helicopter noise. GAO analyzed (1) available data on helicopter operations and noise in the D.C. area for 2017 through 2019, and (2) FAA's approach to responding to helicopter complaints. GAO also interviewed FAA officials; representatives from 18 D.C. area helicopter operators, selected based on operator type and number of flights; and 10 local communities, selected based on factors including geography and stakeholder recommendations. GAO recommends that FAA develop a mechanism to exchange helicopter noise information with operators in the D.C. area. FAA agreed with GAO's recommendation. For more information, contact Heather Krause at (202) 512-2834 or KrauseH@gao.gov.
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  • Three Foreign Nationals Charged with Conspiring to Provide Material Support to ISIS
    In Crime News
    The Justice Department announced today that three Sri Lankan citizens have been charged with terrorism offenses, including conspiring to provide material support to a designated foreign terrorist organization (ISIS).  The men were part of a group of ISIS supporters which called itself “ISIS in Sri Lanka.”  That group is responsible for the 2019 Easter attacks in the South Asian nation of Sri Lanka, which killed 268 people, including five U.S. citizens, and injured over 500 others, according to a federal criminal complaint unsealed today.
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  • Federal Court Orders North Carolina Pharmacy, Pharmacy Owner, and Pharmacist-in-Charge to Pay More Than $1 Million and Stop Dispensing Opioids
    In Crime News
    A federal court in the Eastern District of North Carolina entered a consent judgment and injunction requiring a North Carolina pharmacy, Seashore Drugs Inc., its owner, John D. Waggett, and its pharmacist-in-charge, Billy W. King II, to pay $1,050,000.00 in civil penalties and to cease dispensing opioids or other controlled substances, the Department of Justice announced.
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  • North Carolina Man Sentenced for Violating Fair Housing Act and Threatening a Family Because of Their Race
    In Crime News
    The Justice Department announced today that Douglas Matthew Gurkins, 34,was sentenced to 28 months in prison, followed by three years supervised release, for using threats of force against an African American family because of the family members’ race and because they were renting a dwelling.
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  • Operation Legend: Case of the Day
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    Each weekday, the Department of Justice will highlight a case that has resulted from Operation Legend. Today’s case is out of the Eastern District of Michigan. Operation Legend launched in Detroit on July 29, 2020, in response to the city facing increased homicide and non-fatal shooting rates.
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  • Aviation Safety: Actions Needed to Evaluate Changes to FAA’s Enforcement Policy on Safety Standards
    In U.S GAO News
    The Federal Aviation Administration (FAA) directed individual offices to implement the Compliance Program, and FAA has increasingly used compliance actions rather than enforcement actions to address violations of safety standards since starting the Compliance Program. FAA revised agency-wide guidance in September 2015 to emphasize using compliance actions, such as counseling or changes to policies. Compliance actions are to be used when a regulated entity is willing and able to comply and enforcement action is not required or warranted, e.g., for repeated violations, according to FAA guidance. FAA then directed its offices—for example, Flight Standards Service and Drug Abatement Division—to implement the Compliance Program as appropriate, given their different responsibilities and existing processes. Under the Compliance Program, data show that selected FAA offices have made increasing use of compliance actions. Total Number of Federal Aviation Administration Enforcement Actions and Number of Compliance Actions Closed for Selected Program Offices, Fiscal Years 2012-2019 No specific FAA office or entity oversees the Compliance Program. FAA tasked a working group to lead some initial implementation efforts. However, the group no longer regularly discusses the Compliance Program, and no office or entity was then assigned oversight authority. As a result, FAA is not positioned to identify and share best practices or other valuable information across offices. FAA established goals for the Compliance Program—to promote the highest level of safety and compliance with standards and to foster an open, transparent exchange of data. FAA, however, has not taken steps to evaluate if or determine how the program accomplishes these goals. Key considerations for agency enforcement decisions state that an agency should establish an evaluation plan to determine if its enforcement policy achieves desired goals. Three of eight FAA offices have started to evaluate the effects of the Compliance Program, but two offices have not yet started. Three other offices do not plan to do so—in one case, because FAA has not told the office to. FAA officials generally believe the Compliance Program is achieving its safety goals based on examples of its use. However, without an evaluation, FAA will not know if the Compliance Program is improving safety or having other effects—intended or unintended. FAA supports the safety of the U.S. aviation system by ensuring air carriers, pilots, and other regulated entities comply with safety standards. In 2015, FAA announced a new enforcement policy with a more collaborative and problem-solving approach called the Compliance Program. Under the program, FAA emphasizes using compliance actions, for example, counseling or training, to address many violations more efficiently, according to FAA. Enforcement actions such as civil penalties are reserved for more serious violations, such as when a violation is reckless or intentional. The FAA Reauthorization Act of 2018 included a provision that GAO review FAA's Compliance Program. This report examines (1) how FAA implemented and used the Compliance Program and (2) how FAA evaluates the effectiveness of the program. GAO analyzed FAA data on enforcement actions agency-wide and on compliance actions for three selected offices for fiscal years 2012 to 2019 (4 years before and after program start).GAO also reviewed FAA guidance and interviewed FAA officials, including those from the eight offices that oversee compliance with safety standards. GAO is making three recommendations including that FAA assign authority to oversee the Compliance Program and evaluate the effectiveness of the program in meeting goals. FAA concurred with the recommendations. For more information, contact Heather Krause at (202) 512-2834 or krauseh@gao.gov.
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