They are exploiting the Medicaid system by prescribing hundreds of millions of dollars worth of dangerous drugs that are feeding a booming black market and adding to a torrent of fatal overdoses.
Regulators, for the most part, have failed to curb wild excesses in billing as pain-relief patches, sleeping pills, tranquilizers and other highly abused drugs have poured out over the past three years, frequently in staggering doses.
"This is a crime in plain sight," said David Moye, director of economic crimes and health care fraud for the Florida Attorney General's Office.
In a hand search of more than 2,000 reports of prescription drug deaths and a computer analysis of millions of pharmacy billing records the state has never made public before, the newspaper found that:
Medicaid, which serves about 2 million disabled and low-income Floridians, more than half of them children, paid pharmacies $346.6 million for narcotics and other potent drugs over the past three years. Frequently, the Medicaid prescriptions were for the maximum doses.
Less than 3 percent of the state's medical professionals issued the vast majority of these prescriptions. Sixteen doctors each ordered more than $1 million worth of dangerous drugs. By comparison, only 574 of the state's 56,926 medical professionals topped even $100,000 in pharmacy billings. Most prescribed less than a tenth that amount. Thousands of others wrote far less.
Many doctors who handed out the most prescriptions also are linked to multiple drug-related deaths. At least 40 doctors each had four or more patients die of overdoses in the past two years. Sixteen of the physicians had eight or more such deaths. How many of the dead also were Medicaid participants could not be determined from available records.
As doctors have switched patients from OxyContin, which has been linked to deaths and is highly addictive, three other painkillers have grown in popularity and are killing Floridians with alarming frequency.
Medicaid purchases of methadone, morphine and fentanyl have more than doubled since 2000, and deaths that can be linked to those narcotics have skyrocketed.
"We've got to get our hands around this and do everything we can," State Attorney General Charlie Crist said when shown the newspaper's findings. He promised immediate reforms and legislative proposals for tougher enforcement. "Unfortunately, too many lives have been lost."
James R. McDonough, director of the governor's advisory Office of Drug Control, agreed: "This is truly an epidemic with tragic consequences. There are many holes in the system."
Florida, state regulators admit, is paying dearly in human life and tax dollars for failing to set up a warning system that identifies abuse-prone medicines and monitors doctors who habitually prescribe them.
Doctors such as Freeland Williams II, a general practitioner in Vero Beach.
In 1993, Williams paid a $5,000 fine and accepted three years of probation to settle a Florida Board of Medicine civil complaint that he overprescribed pain pills for three patients, including one without "any objective evidence" of chronic pain, state records show.
Still, during the past three years, Williams prescribed $474,763 worth of controlled drugs for state-supported patients. Only 66 of all the medical professionals in the state had bigger billings, records show.
In 2002, a year when five of his patients fatally overdosed, Williams wrote prescriptions for $237,784 worth of these drugs, nearly triple what he had written two years earlier. That included pain patches for 73 Medicaid patients. Only 15 other doctors wrote more, according to the newspaper's analysis.