Dr. John P. Couch

Drs. John P. Couch and Xiulu Ruan

Practice: Physicians Pain Specialists of Alabama

Specialty: Interventional pain management

Opioid prescriptions paid by Medicare 2013-2015: 71,828

Cost to government: $15.5 million

Discipline: federal convictions and medical-license revocations

Sentence: 20 and 21 years in prison, respectively

Case details:

Pushing opioids to patients made Drs. John P. Couch and Xiulu Ruan very rich men. They attracted supposed chronic-pain sufferers from as many as 18 different states.

In amassing their fortunes, at least 240 of their patients died while under their care.

By 2013, the doctors were top prescribers of opioids – and the pharmacy they owned filled more prescriptions than any other. The FBI and Alabama law enforcement officials took notice and launched an investigation.

Agents determined the doctors prescribing rates were so high they were writing a prescription every four minutes or so. The FBI estimates as many as two-thirds of the patients seen were simply “pill seekers.”

Two employees of the clinic also became addicted to opioids and entered rehab facilities.

In 2014, Ruan began to worry that they would be caught because Alabama had become the No. 1 state for the number of opioid prescriptions written. With 4.8 million residents, Alabama ranked at No. 23 for population.

Ruan encouraged his partner to back away from prescribing so much Roxicodone and Oxycotin because they were the “biggest red flag [sic] . . . especially (because) we are trying to convince AL board of medical examiners that we have a great system.”

Their operation was lucrative, with each doctor collecting millions of dollars from private and tax-payer funded insurance companies. They were also receiving kickbacks from opioid distributors and speaking fees from drug makers.

When the operation was shuttered with the doctors’ indictments in 2015, the FBI seized at least two dozen bank and investment accounts, including their children’s college funds, three houses and two beach houses.

The government also took their cars. Couch had four: Cadillac Escalade, Land Rover, Maserati and a Porsche.

Ruan, however, owned 13 luxury cars including two Ferraris, two Lamborghinis and a Spyker Laviolette that sells for around $200,000.

They were convicted in 2017. Each will spend at least two decades in a federal prison and owe more than $32 million in restitution to the U.S. government.

— Jill Riepenhoff, Investigative Producer, Raycom Media