Background
Evann Herrell, Mark Grenkoski, and Keri McFarlane were licensed physicians who worked at Express Health Care, a clinic that operated as a pill mill rather than a legitimate addiction treatment facility. The clinic prescribed high volumes of controlled substances, including buprenorphine and benzodiazepines, often after brief visits and without proper medical screening. The doctors engaged in fraudulent practices such as falsifying medical records, submitting unnecessary drug tests to Medicare, and shifting patient classifications to evade regulatory caps. After a thirty-day jury trial, all three defendants were convicted of conspiracy to distribute controlled substances, healthcare fraud, and money laundering.
The court’s reasoning
The Sixth Circuit reviewed the defendants’ challenges to their convictions and sentences. Regarding sufficiency of the evidence, the court found that the government presented ample proof that the defendants subjectively knew their prescriptions were not for a legitimate medical purpose, citing their abnormal prescribing habits, lack of patient screening, and admissions by McFarlane. The court affirmed evidentiary rulings, including the exclusion of evidence regarding the later repeal of the X-waiver rule, noting the timeline mismatch rendered it of little probative value. The court also upheld the admission of speculative testimony, hearsay statements used to show effect on the listener, and text messages, finding no abuse of discretion. Finally, the court rejected McFarlane’s motion to sever, finding no specific and compelling prejudice from the joint trial.
Because most of these challenges are meritless, and any errors that did occur were harmless, we affirm.
United States v. Herrell, 26a0171p.06 (6th Cir. 2026)
What it means going forward
The decision reinforces the standard for prosecuting pill mill operators by confirming that subjective knowledge of unauthorized prescribing can be inferred from a pattern of reckless and fraudulent medical practices. It clarifies that post-conspiracy regulatory changes are generally inadmissible to prove state of mind during the conspiracy.