What Happened

A federal judge approved a consent decree between the United States and Upton Care Pharmacy, Inc. and its pharmacist, Abtin Youssefi-Rashti, resolving civil allegations that the Germantown, Maryland pharmacy dispensed controlled substances in violation of the Controlled Substances Act.

The government alleged that between 2018 and when Upton Care closed in 2022, Youssefi-Rashti and the pharmacy knowingly filled fraudulent prescriptions for controlled substances while ignoring red flags that the prescriptions were not legitimate. Investigators alleged Youssefi-Rashti dispensed controlled substances to more than 300 patients who traveled over 180 miles to reach the pharmacy, regularly filled concurrent prescriptions for opioids and stimulants for the same patient, and routinely accepted cash payment even when the patient had insurance available. The government also alleged he dispensed doses causing patients' morphine milligram equivalents to run as high as roughly 1,800 MME per day, far above the CDC's recommended ceiling of 90 MME.

Under the consent decree, approved in May 2023, Youssefi-Rashti agreed to pay a $100,000 civil penalty, surrender his pharmacist's license to the Maryland Board of Pharmacy and not reapply for at least three years, and Upton Care agreed to voluntarily surrender its DEA registration for cause. The decree also requires identifying specific red flags — including prescriptions exceeding 90 daily MME and cash payment despite available insurance — and documenting in detail how any such red flag was resolved before filling the prescription.

What Went Wrong

A retail pharmacy filled high-risk prescriptions for years without a documented process to catch or resolve red flags. Key failures included:

  • Patients traveling more than 180 miles to fill prescriptions were not treated as a red flag warranting additional scrutiny before dispensing.
  • Concurrent opioid-and-stimulant prescriptions for the same patient — a dangerous combination — were filled without documented clinical justification.
  • Cash payment despite available insurance, a well-known diversion indicator, did not trigger heightened review.
  • Daily MME levels many times above CDC guidance were dispensed routinely rather than being capped or escalated for pharmacist review.

How It Could Have Been Prevented

  • Require documented resolution of specific red flags — long travel distance, high MME, dangerous drug combinations, cash payment despite insurance — before filling any flagged prescription.
  • Set a hard MME ceiling that requires pharmacist-in-charge sign-off and prescriber contact before dispensing above it.
  • Flag concurrent opioid-and-stimulant prescriptions for mandatory clinical review rather than routine fill.
  • Track patient travel distance relative to the pharmacy's typical service area and flag outliers for review.

Related Guidance

Sources