Title: Commonwealth v. Stirlacci
Citation: N/A
Docket Number: SJC-12735
State: Massachusetts
Issuer: Massachusetts Supreme Court
Date: January 8, 2020

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SJC-12735 
 
COMMONWEALTH  vs.  FRANK STIRLACCI 
(and 135 companion cases1). 
 
 
 
Hampden.     September 5, 2019. - January 8, 2020. 
 
Present:  Gants, C.J., Lenk, Gaziano, Lowy, Budd, Cypher, 
& Kafker, JJ. 
 
 
Controlled Substances.  Doctor, Controlled substances, 
Prescription.  Health Care. 
 
 
 
 
Indictments found and returned in the Superior Court 
Department on January 26, 2017. 
 
 
Motions to dismiss were heard by Mark D. Mason, J. 
 
 
The Supreme Judicial Court on its own initiative 
transferred the case from the Appeals Court. 
 
 
 
Benjamin Shorey, Assistant District Attorney, for the 
Commonwealth. 
 
A.J. O'Donald III for Frank Stirlacci. 
 
Roy H. Anderson for Jessica Miller. 
 
 
                     
 
1 Sixty-seven against Frank Stirlacci and sixty-eight 
against Jessica Miller. 
2 
 
 
 
LENK, J.  In 2017, a Hampden County grand jury indicted Dr. 
Frank Stirlacci and his office manager, Jessica Miller, for 
numerous violations of the Controlled Substances Act, and for 
submitting false health care claims to insurance providers.  The 
charges under the Controlled Substances Act included twenty-six 
counts each of improper prescribing, G. L. c. 94C, § 19 (a), and 
twenty counts each of uttering a false prescription, G. L. 
c. 94C, § 33 (b).  The defendants also were indicted on twenty-
two charges each of submitting a false health care claim, G. L. 
c. 175H, § 2. 
 
A Superior Court judge subsequently dismissed the 
indictments for improper prescribing and uttering false 
prescriptions.  Because of insufficient evidence, the judge also 
expressed an intent to dismiss six of the twenty-two indictments 
against each defendant for submitting false health care claims.  
The Commonwealth appealed from the dismissals pursuant to Mass. 
R. Crim. P. 15 (a) (1), as amended, 476 Mass. 1501 (2017). 
 
For the reasons that follow, we conclude that there was 
sufficient evidence to indict Stirlacci on twenty-six counts of 
improper prescribing, but that Miller's status as a 
nonpractitioner precludes her indictment under that provision.  
We conclude further that there was insufficient evidence to 
indict either defendant for uttering false prescriptions.  
Finally, there was sufficient evidence to indict both defendants 
3 
 
 
on twenty of the twenty-two counts against each defendant of 
submitting false health care claims, in violation of G. L. 
c. 175H, § 2. 
 
1.  Background.  We recite the facts as the grand jury 
could have found them, reserving some details for subsequent 
discussion.  The Commonwealth's investigation of Stirlacci, a 
physician who operated a solo practice with offices in Agawam 
and Springfield,2 stemmed from a number of prescriptions issued 
between April 17, 2015, and May 11, 2015, while he was 
incarcerated in Louisville, Kentucky.3  Of particular concern to 
investigators were fifteen prescriptions for hydrocodone, six 
prescriptions for oxycodone, two prescriptions for fentanyl, and 
three prescriptions for methadone.4 
 
As part of its investigation, the Commonwealth obtained 
recordings of Stirlacci's telephone calls made from the 
Louisville facility where he was being held.  In these 
conversations, he spoke of his inability to raise money to 
                     
 
2 Between the two offices, Stirlacci apparently treated 
approximately 3,000 patients. 
 
 
3 Stirlacci was held in contempt of court in Kentucky for 
being delinquent on spousal support payments.  He was 
incarcerated from April 17, 2015, to May 11, 2015. 
 
 
4 Although it appears from the record that additional 
prescriptions may have been issued, during the period that 
Stirlacci was being held, for substances other than narcotics, 
these twenty-six prescriptions were the focus of the 
indictments. 
4 
 
 
satisfy his alimony obligations if he remained incarcerated and 
unable to see patients.  In addition, he expressed concern that 
he needed to maintain sufficient cash flow to keep his practice 
open, that he was abandoning his patients, and that he could 
incur liability if a patient suffered an injury as a result of 
not being able to obtain necessary medication. 
 
When Stirlacci was on vacation or otherwise out of the 
office, he typically would leave pre-signed prescription forms 
for Miller, who was not a medical professional, to use for 
patients who came in for prescription renewals.  While Stirlacci 
was in jail, he instructed Miller that, if a patient came in 
seeking a renewal, she should issue it and also submit a claim 
to the patient's insurance company.  Miller sought to clarify 
whether she could submit claims for visits where Stirlacci would 
not have seen the patient.  Stirlacci told her that even if he 
did not see the patient, the office was "doing work" and should 
submit a claim.  He also explained that such claims would be 
"down charg[ed]" because the patient had not seen a doctor.5 
 
Subsequent conversations between Miller and Stirlacci 
reveal Stirlacci's mounting frustration with his inability to 
                     
 
5 The grand jury were not provided with a definition of 
"down charging," but could have inferred that the phrase implied 
that a medical office would bill insurance providers at a lower 
rate if the doctor did not actually see the patient. 
5 
 
 
run his practice, which he worried would "implode" in his 
absence.  The conversations also indicate that a nurse 
practitioner employed by Stirlacci6 raised concerns to Miller 
about the propriety of Miller issuing renewal prescriptions.  In 
addition, the nurse practitioner objected to Miller billing for 
patients who had not been examined by Stirlacci on that date.  
Stirlacci reassured Miller that she knew the proper standards 
for billing, and she should do what she knew was "right."  He 
also expressed frustration with the nurse practitioner's 
unwillingness to recognize that small private practices could 
not afford to follow every regulation if they were going to be 
successful businesses and remain flexible enough to accommodate 
patients. 
 
In January of 2017, the Commonwealth convened a grand jury 
to present the results of its investigation.  The evidence 
submitted to the grand jury included a complete transcript of 
Stirlacci's telephone calls with Miller and other associates 
while he was incarcerated in Kentucky.  It also included records 
for twenty-two patients who either were issued prescriptions, or 
whose insurance providers were billed for office visits, on 
dates when Stirlacci was in Kentucky and Miller was working in 
                     
 
6 The nurse practitioner ultimately left the practice on 
May 7, 2015, before Stirlacci returned from Kentucky after 
May 11, 2015. 
6 
 
 
the office.  These records included copies of twenty-six 
prescriptions for narcotics, all issued on dates when Stirlacci 
was in Kentucky and Miller was at the office.7  The records also 
included copies of billing entries showing that each patient's 
insurance provider had been billed for an office visit on a date 
when Stirlacci was in Kentucky.  In some instances, the records 
also included documents from the patients' insurance companies 
that referenced the reimbursement claims, thus indicating that a 
claim had been made. 
 
The Commonwealth's sole witness was a State police trooper 
who had worked on the investigation.  Although the trooper did 
not provide a detailed explanation of medical billing practices 
or what the specific billing codes in the patient records meant, 
he stated that the records showed that the patients' insurance 
providers were billed for the patients having seen Stirlacci.  
The trooper further explained that Stirlacci was not directly 
issuing the prescriptions from jail, but that Miller was filling 
out the prescriptions using blank prescription forms that had 
been pre-signed by Stirlacci.  The trooper also confirmed that 
all the prescriptions were renewals for ongoing treatment. 
                     
 
7 As discussed supra, fifteen prescriptions were for 
hydrocodone, six were for oxycodone, two were for fentanyl, and 
three were for methadone.  Stirlacci's case load was 
approximately 3,000 patients between his two offices. 
7 
 
 
 
The trooper read two excerpts from the transcripts of 
Stirlacci's telephone calls to Miller while he was incarcerated.  
In the first conversation, Stirlacci directed Miller to issue 
prescriptions and submit billing charges for the times when 
patients came to the office to pick up (renewal) prescriptions.8  
In the second excerpt, Stirlacci and Miller discussed the nurse 
practitioner's concerns with this arrangement.9  The trooper also 
testified that he had interviewed that nurse practitioner, and 
read the grand jury her written statement.  Her statement 
                     
 
8 The first excerpt stated in part: 
 
Miller:  "What about people that are picking up scripts, 
can I put in charges for them?" 
 
Stirlacci:  "Yes" 
 
Miller:  "Even though they weren't seen?" 
 
Stirlacci:  "Yes.  Put in the 99212. . . .  For the date 
that they picked them up, because they didn't see the 
doctor, so it's down charged.  So, it's a 92 or a 93. . . .  
Anything and everything you can get in, get in." 
 
 
9 The second excerpt reads as follows: 
 
Miller (summarizing a conversation she had had with the 
nurse practitioner)]:  "Doc is the one that makes any 
decisions.  He told me to write scripts, so I'm writing 
scripts." 
 
Stirlacci:  "Right.  So what does she [not] like?  The 
patients were seen, they came into the office." 
 
Miller:  "She doesn't like [that we are] writing scripts 
for patients and then expecting her to do the office 
thing." 
8 
 
 
provided an account of the manner in which Stirlacci's medical 
practice operated in his absence.  In addition, the nurse 
practitioner said that the signatures on the prescription forms 
issued in Stirlacci's absence were in Stirlacci's handwriting, 
but that the details of the prescriptions were in Miller's.  The 
nurse practitioner mentioned requests she had received from 
Miller and from the Springfield office manager (Miller only 
managed the Agawam office) to complete patient notes for 
patients she herself had not seen; she refused these requests. 
 
Stirlacci and Miller each were indicted on twenty-six 
charges of improper prescribing, G. L. c. 94C, § 19 (a); twenty 
charges of uttering false prescriptions, G. L. c. 94C, § 33 (b); 
and twenty-two charges of submitting false health care claims, 
G. L. c. 175H, § 2.  After a hearing on the defendants' joint 
motion to dismiss for insufficient evidence to establish 
probable cause, the judge dismissed the indictments for improper 
prescriptions and uttering false prescriptions, and further 
concluded that there was insufficient evidence as to six of the 
twenty-two false health care claims.10  The Commonwealth appealed 
                     
 
10 In order to clarify which specific counts had 
insufficient evidence, the judge ordered the Commonwealth to 
submit a bill of particulars.  This was necessary because the 
individual indictments did not identify the patient to whom they 
pertained.  As further proceedings in the Superior Court were 
stayed pending this appeal, these counts have yet to be 
dismissed. 
9 
 
 
to the Appeals Court, and we transferred the consolidated 
appeals to this court on our own motion. 
 
2.  Discussion.  The Commonwealth contends that the 
evidence indicating that Miller provided pre-signed 
prescriptions to patients when Stirlacci was not present 
established probable cause either that the prescriptions lacked 
a legitimate medical purpose or that they were issued outside 
the usual course of professional practice.11  The Commonwealth 
also maintains that evidence that Miller filled out 
prescriptions which had been pre-signed by Stirlacci established 
probable cause that both defendants uttered false prescriptions, 
and that submitting billing claims for these visits established 
probable cause that both defendants submitted false health care 
claims. 
 
a.  Standard of review.  Although, in general, a "court 
will not inquire into the competency or sufficiency of the 
evidence before the grand jury" (citation omitted), Commonwealth 
v. Robinson, 373 Mass. 591, 592 (1977), a "grand jury must hear 
sufficient evidence to establish the identity of the 
accused . . . and probable cause to arrest him [or her]" for the 
                     
 
11 As discussed in part 2.a, infra, the Commonwealth 
contends that it is sufficient to establish probable cause that 
either the prescriptions lacked a legitimate medical purpose or 
the prescriptions were issued outside the usual course of 
practice. 
10 
 
 
crime charged, Commonwealth v. McCarthy, 385 Mass. 160, 163 
(1982).  A grand jury may indict when presented with sufficient 
evidence of "each of the . . . elements" of the charged offense.  
Commonwealth v. Moran, 453 Mass. 880, 884 (2009). 
 
Probable cause is a "considerably less exacting" standard 
than that required to support a conviction at trial.  
Commonwealth v. O'Dell, 392 Mass. 445, 451 (1984).  It requires 
"sufficient facts to warrant a person of reasonable caution in 
believing that an offense has been committed," not proof beyond 
a reasonable doubt.  Commonwealth v. Levesque, 436 Mass. 443, 
447 (2002).  An appellate court reviews the evidence underlying 
a grand jury indictment in the light most favorable to the 
Commonwealth.  See Commonwealth v. Catalina, 407 Mass. 779, 781 
(1990).  In considering a judge's decision to dismiss for lack 
of sufficient evidence, we do not defer to the judge's factual 
findings or legal conclusions.  See Commonwealth v. Ilya I., 470 
Mass. 625, 627 (2015). 
 
b.  Improper prescribing in violation of G. L. c. 94C, 
§ 19 (a).  The Controlled Substances Act mandates that valid 
prescriptions for controlled substances "be issued for a 
legitimate medical purpose by a practitioner acting in the usual 
course of his [or her] professional practice."  G. L. c. 94C, 
§ 19 (a).  Practitioners who issue invalid prescriptions are 
subject to criminal penalties.  Id.  To determine whether the 
11 
 
 
indictments should have been dismissed, we must (a) establish 
the standard for "improper prescribing" by defining the 
relationship between "legitimate medical purpose" and "usual 
course of professional practice"; (b) assess whether the 
Commonwealth presented sufficient evidence to establish probable 
cause that there was improper prescribing by a practitioner, and 
(c) decide whether the explicit reference to practitioners in 
the Controlled Substances Act precludes liability for a 
nonpractitioner such as Miller.  We conclude that the 
Commonwealth has met its burden with respect to Stirlacci, but 
that G. L. c. 94C, § 19 (a), does not impose liability on 
nonpractitioners such as Miller. 
 
i.  Standard for "improper prescribing."  "[A] statute must 
be interpreted according to the intent of the Legislature 
ascertained from all its words construed by the ordinary and 
approved usage of the language" (citation omitted).  Seideman v. 
Newton, 452 Mass. 472, 477 (2008).  In order to effectuate the 
intent of the Legislature, we consider the text "in connection 
with the cause of its enactment . . . and the main object to be 
accomplished." (citation omitted).  Id.  We discern the intent 
"from all [of a statute's] parts and from the subject matter to 
which it relates."  Id.  We also consider a statute within the 
context of the broader statutory framework, including prior 
versions of the same statute and similar enactments.  See 
12 
 
 
Bellalta v. Zoning Bd. of Appeals of Brookline, 481 Mass. 372, 
378 (2019). 
 
A.  Defining "legitimate medical purpose" and "usual course 
of professional practice."  General Laws c. 94C, § 19 (a), 
provides that a valid prescription is one issued "for a 
legitimate medical purpose by a practitioner acting in the usual 
course of his [or her] professional practice."  G. L. c. 94C, 
§ 19 (a).  Articulating a standard for improper prescribing 
requires us to define these two concepts and to determine their 
respective roles in distinguishing valid prescribing from 
criminal conduct. 
 
The Commonwealth argues that it is sufficient to prove 
either that a prescription lacked a legitimate medical purpose 
or that it was issued outside the usual course of professional 
practice.  In the Commonwealth's view, G. L. c. 94C, § 19 (a), 
imposes two distinct requirements for a valid prescription:  
that it (1) have a "legitimate medical purpose" and (2) be 
issued in the "usual course of professional practice."  Thus, 
the Commonwealth argues, a prescription is improper if the 
Commonwealth can prove that a practitioner failed to meet just 
one of these requirements. 
 
We are not convinced by this argument.  General Laws 
c. 94C, § 19 (a), provides that a valid prescription is one 
issued "for a legitimate medical purpose by a practitioner 
13 
 
 
acting in the usual course of his [or her] professional 
practice."  To read "legitimate medical purpose" and "usual 
course of professional practice" as two distinct requirements 
would require inserting the word "and" between the two phrases.  
We "refrain from reading into the statute . . . words that the 
Legislature . . . chose not to include" (quotation and citation 
omitted).  Essex Regional Retirement Bd. v. Swallow, 481 Mass. 
241, 252 (2019).  Moreover, for the reasons that follow, we 
conclude that "legitimate medical purpose" and "usual course of 
professional practice" are best read as a single, holistic 
standard. 
 
Because neither "legitimate medical purpose" nor "usual 
course of professional practice" are defined anywhere in the 
statute, we turn first to the ordinary usage of this language.  
"Purpose" implies one's goal or intent, Black's Law Dictionary 
1493 (11th ed. 2019), while "legitimate" implies something that 
is "genuine" or "lawful," see id. at 1084.  Accordingly, 
"legitimate medical purpose" may be read as a genuine or lawful 
medical intent or goal.  "Usual" implies "ordinary" or 
"customary."  See id. at 1857.  "Course" implies a "routine."  
See, e.g., id. at 443 (defining "course of business" as "[t]he 
normal routine of managing a trade or business" [emphasis 
added]).  "Professional" means "pertaining to one's profession," 
here, the medical profession.  See Dorland's Illustrated Medical 
14 
 
 
Dictionary 1514 (30th ed. 2003).  The "usual course of 
professional practice" thus may be read to mean the routines 
customarily expected in the context of the medical profession.  
See United States v. Smith, 573 F.3d 639, 647-648 (8th Cir. 
2009) ("usual course of professional practice" refers to 
"generally recognized and accepted medical practices" [citation 
omitted]). 
 
From the plain language, then, we can infer that the 
relevant factors when determining if a practitioner has engaged 
in improper prescribing are whether the practitioner's intent is 
not related to a genuine medical objective, and the degree to 
which the practitioner's conduct deviates from "generally 
recognized and accepted medical practices."  See Smith, 573 F.3d 
at 647.  What remains unclear is the precise relationship 
between these factors.  We therefore turn from the text to a 
broader consideration of the objectives of the statute. 
 
B.  Purpose of G. L. c. 94C, § 19 (a).  When crafting the 
Controlled Substances Act, the Legislature recognized the need 
to strike a careful balance between allowing medical 
practitioners to prescribe narcotics where appropriate as 
medical treatment and preventing the same practitioners from 
abusing this power to promote the unlawful distribution of these 
drugs.  By its terms, G. L. c. 94C, § 19 (a), both serves to 
create "an exemption from criminal liability" for practitioners 
15 
 
 
who issue proper prescriptions and a "gateway to liability" that 
"makes it possible to prosecute physicians" who issue improper 
prescriptions.  See Commonwealth v. Brown, 456 Mass. 708, 717-
718 (2010).  This fundamental legislative intent can be traced 
to previous drug laws in the Commonwealth, which use similar 
language and reflect a concern with ensuring that medical 
professionals do not use their prescribing authority to evade 
narcotics controls.12 
 
To preserve this careful balance, courts also have held 
that the prohibition on improper prescribing does not establish 
criminal liability merely for medical malpractice.  "It is not 
enough to show that the physician did not comply with accepted 
medical practice."  Commonwealth v. Kobrin, 72 Mass. App. Ct 
589, 596 (2008).  In Commonwealth v. Comins, 371 Mass. 222, 232 
(1976), cert. denied, 430 U.S. 946 (1977), we observed that 
"mere malpractice in the prescribing of drugs has not been made 
a crime," and that the physician must not have "intend[ed] to 
achieve a legitimate medical objective." 
                     
 
12 For example, G. L. c. 94, § 200, as appearing in 
St. 1957, c. 660, provided, "A physician . . . in good faith and 
in the course of his [or her] professional practice only, for 
the alleviation of pain and suffering or for the treatment or 
alleviation of disease may prescribe . . . narcotic drugs."  
Similarly, G. L. c. 94, § 199E, as appearing in St. 1957, 
c. 660, exempted certain uses of narcotic drugs so long as they 
were "administered, dispensed and sold in good faith as a 
medicine, and not for the purpose of evading the provisions of 
the narcotic drugs law." 
16 
 
 
 
This approach is consistent with positions adopted by the 
Federal courts in interpreting the Comprehensive Drug Abuse 
Prevention and Control Act of 1970, 21 U.S.C. §§ 801 et seq., on 
which the Commonwealth's Controlled Substances Act is modeled.  
See Brown, 456 Mass. at 716.  Under the Federal statute, "courts 
have consistently concluded that it is proper to instruct juries 
that a doctor should not be held criminally liable if the doctor 
acted in good faith when treating his [or her] patients."  
United States v. Hurwitz, 459 F.3d 463, 477 (4th Cir. 2006).  
"[T]he government must prove . . . that the practitioner acted 
with intent to distribute the drugs and with intent to 
distribute them outside the course of professional practice."  
United States v. Feingold, 454 F.3d 1001, 1008 (9th Cir.), cert. 
denied, 549 U.S. 1067 (2006).13 
 
C.  Standard for improper prescribing under G. L. c. 94C, 
§ 19 (a).  The distinguishing factor between proper and improper 
prescribing, or between mere malpractice and criminal conduct, 
is the practitioner's intent.  The defining feature of a valid 
                     
 
13 The emphasis on intentional action in United States v. 
Feingold, 454 F.3d 1001, 1007-1008 (9th Cir.), cert. denied, 549 
U.S. 1067 (2006), perhaps reflects the Federal statute's 
explicit prohibition of "knowingly or intentionally" dispensing 
a controlled substance, 21 U.S.C. § 841(a)(1), language not 
included in G. L. c. 94C, § 19 (a).  Because we interpret G. L. 
c. 94C, § 19 (a), to require the Commonwealth to prove that the 
accused practitioner acted without a legitimate medical 
objective, however, the requirement that the Commonwealth prove 
that the practitioner acted with intention is implied. 
17 
 
 
prescription is that it is issued for a legitimate medical 
purpose.  This means that its issuance is the product of "an 
honest exercise of professional judgment as to a patient's 
medical needs . . . in accordance with what [the practitioner] 
reasonably believe[s] to be proper medical practice" (citation 
omitted).  United States v. Volkman, 797 F.3d 377, 387-388 (6th 
Cir.), cert. denied, 136 S. Ct. 348 (2015). 
Read together, "legitimate medical purpose" and "usual 
course of professional practice" capture what separates proper 
prescribing -- including erroneous prescribing that might 
constitute medical malpractice -- from improper prescribing.  
The two statutory phrases are not separate elements but, rather, 
mutually reinforcing concepts.  If a prescription lacks a 
"legitimate medical purpose," it has been issued outside the 
"usual course of professional practice."  See United States v. 
Nelson, 383 F.3d 1227, 1231 (10th Cir. 2004) (no distinction 
between "usual course of professional practice" and "legitimate 
medical purpose" in Comprehensive Drug Abuse Prevention and 
Control Act of 1970 and its implementing regulations). 
Moreover, if a practitioner issues a prescription absent 
any effort to follow the basic routines associated with "the 
usual course of professional practice," this can indicate that a 
prescription was not intended for genuine medical treatment.  
See Comins, 371 Mass. at 232-233 (physician's failure to conduct 
18 
 
 
any medical examination prior to issuing prescriptions supported 
inference that physician acted without legitimate medical 
purpose).14 
In sum, we hold that a practitioner may be found guilty of 
improper prescribing, in violation of G. L. c. 94C, § 19 (a), 
where the Commonwealth can establish that the practitioner 
issued a prescription for a controlled substance for a purpose 
other than genuine medical treatment.  A prescription is not 
issued for genuine medical treatment where a practitioner fails 
to exercise medical judgment in a manner consistent with the 
basic routines associated with such medical treatment.  Because 
mere malpractice does not constitute improper prescribing, a 
practitioner who errs despite a good faith effort to diagnose 
and treat a patient has not violated the statute. 
 
ii.  Probable cause to indict a practitioner for improper 
prescribing.  We turn to whether there was sufficient evidence 
here to sustain the indictments for improper prescribing.  As 
discussed supra, the Commonwealth must establish probable cause 
that (1) a practitioner (2) issued a prescription for a 
controlled substance (3) for a purpose other than genuine 
                     
 
14 For example, in Comins, 371 Mass. at 229-230, 232-233, 
experts testified that the defendant's decisions to prescribe 
drugs requested by patients, or to prescribe drugs without ever 
examining the patient, were contrary to accepted medical 
practice and bolstered the conclusion that the defendant lacked 
a legitimate medical purpose in issuing those prescriptions. 
19 
 
 
medical treatment.  We first determine whether there was 
probable cause to indict Stirlacci.  As there was no dispute 
that Stirlacci is a practitioner, or that the twenty-six 
prescriptions at issue were for controlled substances, the only 
question is whether there was probable cause that the 
prescriptions were issued for a purpose other than genuine 
medical treatment.  We conclude that there was, and thus that 
there was sufficient evidence to indict.15 
 
Viewing the evidence presented to the grand jury in the 
light most favorable to the Commonwealth, we consider what the 
grand jury could have found from the entirety of Stirlacci's 
transcripts, the patient records, and the State police trooper's 
testimony.16  From the evidence the Commonwealth put before them, 
                     
 
15 We nonetheless note, as did the Superior Court judge, 
that the evidence presented to date, taken as true, indicates 
far less egregious conduct than that alleged in prior cases 
enforcing our narcotics laws against physicians.  Compare 
Commonwealth v. Pike, 430 Mass. 317, 321 (1999) (defendant 
stated that he was "local drug pusher"); Comins, 371 Mass. 
at 229 (defendant prescribed drugs at patient's request despite 
patient's statement that patient suffered from substance abuse, 
and defendant issued prescriptions without ever conducting 
medical examination of patient). 
 
 
16 The judge sought guidance from the Board of Registration 
in Medicine's prescribing practices policy and guidelines, which 
enumerate indicators that a prescription may lack a legitimate 
medical purpose.  Because the grand jury were not presented with 
these indicators, however, we decline to consider them in our 
analysis of whether the grand jury could have found probable 
cause on the evidence before them. 
 
20 
 
 
the grand jury reasonably could have inferred that Stirlacci, 
while incarcerated, authorized Miller to issue renewal 
prescriptions for existing patients, using pre-signed 
prescription forms.  The grand jury arguably also could have 
inferred that one motive for doing so was to maintain cash 
flow.17  Most significantly, the grand jury reasonably could have 
inferred that Stirlacci did not know which specific patients 
received renewal prescriptions from Miller.18 
 
From these inferences, even absent expert testimony, the 
grand jury could have found that Stirlacci issued prescriptions 
without exercising individualized medical judgment at the time 
when the renewals were issued.  From this, the grand jury could 
have concluded that Stirlacci issued prescriptions without first 
ascertaining whether they remained appropriate courses of 
treatment.  This was sufficient to establish probable cause that 
the prescriptions were not issued for a legitimate medical 
purpose in the usual course of professional practice.  Such a 
conclusion is further bolstered by a plausible inference that 
                     
 
17 Stirlacci told Miller to "get charges in because that 
brings cash flow."  Stirlacci separately told the manager of his 
Springfield office to "just try to plug in as much as we 
can . . . the pipeline's got to flow." 
 
 
18 In one telephone call, Stirlacci said to Miller, "I don't 
know how many [prescriptions] you wrote today.  I don't know how 
many [pre-signed prescription forms] you have left." 
21 
 
 
Stirlacci's reason for directing Miller to issue the 
prescriptions was, at least in part,19 to maintain the viability 
of his practice.20 
 
iii.  Nonpractitioner liability for improper prescribing 
under G. L. c. 94C, § 19 (a).  We next consider whether G. L. 
c. 94C, § 19 (a), applies to nonpractitioners.  We conclude that 
it does not. 
 
"The starting point of our analysis is the language of the 
statute, 'the principal source of insight into Legislative 
purpose.'"  Simon v. State Examiners of Electricians, 395 Mass. 
238, 242 (1985), quoting Commonwealth v. Lightfoot, 391 Mass. 
718, 720 (1984).  General Laws c. 94C, § 19 (a), imposes 
liability on "practitioners."  Chapter 94C includes an extensive 
definition of "practitioner" that makes no reference to lay 
                     
 
19 The telephone records also revealed Stirlacci's concerns 
about patient abandonment, and the possibility of liability 
should any patients suffer medical injury after not having been 
able to obtain their medicines.  Many patients' records indicate 
multiple chronic diagnoses and nonopioid prescriptions to treat 
chronic conditions, such as high blood pressure. 
 
 
20 Of course, "having . . . a keen profit motive does not 
itself denude a physician of the intention to treat medically a 
patient's condition."  Commonwealth v. Kobrin, 72 Mass. App. Ct. 
589, 607 (2008).  While a profit motive would not alone 
establish probable cause of improper prescribing, it can support 
such a finding when presented, as here, in conjunction with more 
direct evidence that a practitioner lacked a legitimate medical 
purpose. 
22 
 
 
persons employed by medical professionals.21  See G. L. c. 94C, 
§ 1.  Accordingly, Miller cannot be prosecuted directly as a 
practitioner for improper prescribing. 
 
We then consider whether Miller, acting as Stirlacci's 
agent, could be prosecuted as an accessory.  The Commonwealth 
argues that Miller could be held liable if she provided aid to 
Stirlacci with the shared intent to issue prescriptions in bad 
faith.  We construe G. L. c. 94C, § 19 (a), to preclude 
prosecution of nonpractitioners as accessories.  The statutory 
language expressly places "responsibility for the proper 
prescribing . . . of controlled substances . . . upon the 
prescribing practitioner," and a "corresponding 
responsibility . . . with the pharmacist who fills the 
                     
 
21 General Laws c. 94C, § 1, defines a "practitioner" as 
 
"(a) A physician, dentist, veterinarian, podiatrist, 
scientific investigator, or other person registered to 
distribute, dispense, conduct research with respect to, or 
use in teaching or chemical analysis, a controlled 
substance in the course of professional practice or 
research in the commonwealth; 
 
"(b) A pharmacy, hospital, or other institution registered 
to distribute, dispense, conduct research with respect to 
or to administer a controlled substance in the course of 
professional practice or research in the commonwealth. 
 
"(c) An optometrist authorized by [G. L. c. 112, §§ 66 and 
66B,] and registered pursuant to [§ 7 (h)] to utilize and 
prescribe therapeutic pharmaceutical agents in the course 
of professional practice in the commonwealth." 
23 
 
 
prescription."  See G. L. c. 94C, § 19 (a).  "Clear and 
unambiguous language in a statute is conclusive as to 
legislative intent."  Massachusetts Insurers Insolvency Fund v. 
Smith, 458 Mass. 561, 565 (2010).  The statute clearly refers to 
practitioners, and we see no reason to expand its reach.  But 
see United States v. Vamos, 797 F.2d 1146, 1153-1154 (2d Cir. 
1986), cert. denied, 479 U.S. 1036 (1987) (affirming conviction 
of physician's nurse and office manager for aiding and abetting 
distribution of controlled substance, outside scope of medical 
practice, under Federal controlled substances act).22 
 
Interpreting G. L. c. 94C, § 19 (a), as a provision aimed 
specifically at practitioners also is sensible because the 
critical inquiry is whether the prescriptions were issued in 
furtherance of genuine medical treatment.  Because criminal 
liability under G. L. c. 94C, § 19 (a), turns on the exercise of 
medical judgment, the Legislature could not have intended to 
evaluate the intentions of lay persons who lack the authority to 
provide or authorize medical treatment.  We must interpret the 
provision "so as to render the legislation effective, consonant 
with sound reason and common sense" (citation omitted).  
Commonwealth v. Morgan, 476 Mass. 768, 777 (2017).  We thus 
                     
 
22 In Vamos, 797 F.2d at 1153-1154, however, the court was 
not presented directly with the question whether 
nonpractitioners could be prosecuted; at issue was the proper 
standard of liability. 
24 
 
 
conclude that Miller cannot be prosecuted for improper 
prescribing under the Controlled Substances Act, and the 
indictments against her charging violations of G. L. c. 94C, 
§ 19 (a), properly were dismissed.23 
 
c.  Uttering a false prescription, in violation of G. L. 
c. 94C, § 33 (b).  General Laws c. 94C, § 33 (b), prohibits 
"utter[ing] a false prescription for a controlled substance," 
and "knowingly or intentionally acquir[ing] . . . possession of 
a controlled substance by means of forgery, fraud, deception or 
subterfuge."  The Commonwealth argues that the prescriptions at 
issue were "false" because they conveyed to the pharmacist the 
false impression that a doctor had been present to issue them, 
and because Miller altered the pre-signed prescription forms by 
filling in the details of each prescription.  We reach a 
different conclusion.  In our view, a prescription is "false" 
when it lacks genuine authorization, such as when a person 
issues a prescription with fake credentials, or "borrows" 
                     
23 This is not to say that nonpractitioners are altogether 
immune from liability under the Controlled Substances Act.  
General Laws c. 94C, § 19 (a), is but one component of the act's 
comprehensive framework for regulating controlled substances, 
focused specifically on preventing practitioners from abusing 
their prescribing authority to engage in illicit distribution of 
such drugs.  For example, had Miller issued the same 
prescriptions in Stirlacci's name, but without his permission, 
she could have been prosecuted for uttering false prescriptions 
under G. L. c. 94C, § 33 (b). 
25 
 
 
another practitioner's genuine credentials without that 
practitioner's involvement or consent. 
 
i.  Definition of "uttering a false prescription."  To 
determine whether the indictments charging this offense should 
have been dismissed, we first must decide what conduct "uttering 
a false prescription" circumscribes.  More specifically, we must 
identify what makes a prescription "false." 
 
We begin with the plain statutory language, "the principal 
source of insight into Legislative purpose" (citation omitted).  
See Simon, 395 Mass. at 242.  Three words -- "prescription," 
"utter," and "person" -- have particular significance.  Under 
the Controlled Substances Act, a "prescription" may be issued 
only by a registered practitioner who is authorized to prescribe 
controlled substances.  See G. L. c. 94C, § 18 (a)-(b).  While 
provisions of the Controlled Substances Act that regulate 
prescriptions generally refer to "practitioners,"24 G. L. c. 94C, 
§ 33 (b), notably refers to "persons."  The act defines "person" 
broadly to include individuals, businesses, and other entities.  
See G. L. c. 94C, § 1.  Although the definition of "person" does 
                     
 
24 See, e.g., G. L. c. 94C, § 1 (defining oral and written 
prescriptions as orders to dispense medication by 
"practitioner"); G. L. c. 94C, § 17 (a)-(b) (no Schedule II 
controlled substance may be dispensed without prescription by 
"practitioner"); G. L. c. 94C, § 18 (a)-(b) (prescriptions for 
controlled substances may be issued only by registered, 
authorized "practitioner"); G. L. c. 94C, §§ 19-19D (regulating 
conditions in which practitioners issue prescriptions). 
26 
 
 
not exclude "practitioners," a key distinction between the two 
is that only practitioners may prescribe drugs.  One conclusion 
we thus can draw from the Legislature's choice to punish 
"persons" who utter false prescriptions is that the 
Legislature's focus was on those who lack prescribing authority. 
 
We likewise presume that the choice to punish "uttering" 
was intentional.  See Simon, 395 Mass. at 243 (where word has 
technical meaning, court will adopt that meaning).  "Uttering" 
is defined as "presenting a false or worthless instrument with 
the intent to harm or defraud."  Black's Law Dictionary, supra 
at 1860.  "The elements of the crime of uttering . . . are 
'(1) offering as genuine; (2) an instrument; (3) known to be 
forged; (4) with the intent to defraud'" (citation omitted).  
Commonwealth v. O'Connell, 438 Mass. 658, 664 n.9 (2003).  
"Uttering" involves the deliberate use of an instrument falsely 
to convey authorization or entitlement.  In this vein, 
"uttering" has been applied to the presentation of forged 
checks.  See id. at 663 (sufficient evidence to convict of 
uttering where defendant cashed forged checks because logical 
inference was that defendant intended to convince bank to 
release funds); Commonwealth v. Analetto, 326 Mass. 115, 118-119 
(1950) (check forger may be presumed to intend that payer will 
act under false impression that check is genuine). 
27 
 
 
 
The analogy to a forged check helps illustrate the types of 
false statements that "uttering" proscribes.  When one "utters" 
a forged check, one falsely conveys that the specified funds 
were released by a person with the authority to do so.  Just as 
a check authorizes the release of funds on the authority of the 
account holder, a prescription authorizes the dispensation of 
drugs on the authority of a licensed prescriber.  We therefore 
can infer that a person "utters a false prescription" by 
deliberately issuing a prescription that appears real, but which 
actually was not issued by the authorized practitioner named in 
the prescription. 
 
We draw further support for this reading from previous 
versions of the statute.  See Bellalta, 481 Mass. at 378.  In 
1917, the Legislature enacted criminal penalties for any person 
"who, not being an authorized physician, dentist or 
veterinarian . . . knowingly issues or utters a prescription or 
written order falsely made or altered" (emphasis added).  See 
St. 1917, c. 275, § 6.  Subsequent revisions of this provision 
no longer include an explicit description of "uttering" as an 
offense committed by persons not authorized to practice 
medicine.  Nonetheless, the revised versions retained language 
that reflects an intent to punish persons who misrepresent 
28 
 
 
themselves as having the authority to issue prescriptions.25  We 
thus conclude that a "false prescription" is one that falsely 
purports to have been issued by an authorized practitioner.26 
ii.  Sufficiency of the evidence to sustain the 
indictments.  Even when viewed in the light most favorable to 
the Commonwealth, there is no evidence that either defendant 
deliberately appropriated false prescribing authority.  It may 
be that, technically, Miller "altered" the prescriptions.  There 
is no evidence, however, that Miller believed that she was 
exceeding the bounds of Stirlacci's authority.  Stirlacci, of 
course, neither forged nor altered the prescriptions; the 
signature was his, and he directed Miller to fill in the rest. 
It also is relevant that the prescriptions at issue were 
renewals of ongoing treatment, as opposed to entirely new 
prescriptions.  Because the prescriptions were renewals, Miller 
                     
 
25 For example, G. L. c. 94, § 203 (4), (5), as appearing in 
St. 1957, c. 660, provided that "[n]o person shall make or utter 
any false or forged prescription," but separately provided that 
"no person shall, for the purpose of obtaining a narcotic drug, 
falsely assume the title of . . . a manufacturer, wholesaler, 
pharmacist, physician, dentist, veterinarian, or other 
authorized person." 
 
26 To be clear, we are not suggesting that a practitioner 
never could utter a false prescription.  For example, if a 
practitioner were to issue a prescription for a substance the 
practitioner was not formally authorized to prescribe, or to use 
credentials that were false, inactive, or assigned to another 
practitioner, the practitioner would be in violation of the 
statute. 
29 
 
 
simply had to rely on Stirlacci's prior prescription to complete 
the new prescription form.  She did not engage in any "new" 
medical decision-making, thereby acting entirely within the 
scope of Stirlacci's genuine prescribing authority.  Although 
not present, Stirlacci thus effectively dictated the substance 
of the prescription by virtue of his prior decision to authorize 
treatment.  In sum, each prescription in the present case was 
presented as having been issued by Stirlacci, and was, in fact, 
issued by him.  The prescriptions were not "false" because 
Stirlacci authorized their issuance on the basis of his genuine 
authority to prescribe the indicated drugs.  We thus conclude 
that the indictments under G. L. c. 94C, § 33 (b), properly were 
dismissed. 
d.  Submitting false health care claims in violation of 
G. L. c. 175H, § 2.  We next consider whether there was probable 
cause to indict the defendants for submitting false health 
claims under G. L. c. 175H, § 2.  The Commonwealth contends that 
the records of twenty-two patients establish probable cause that 
the defendants knowingly made false statements by using billing 
codes that would indicate to insurance companies that Stirlacci 
had seen the patients.  The judge agreed with respect to sixteen 
patients.  We conclude that there was probable cause with 
respect to twenty of the twenty-two counts against each 
defendant. 
30 
 
 
General Laws c. 175H, § 2, makes it a crime "knowingly and 
willfully" to make a false statement or to misrepresent a 
material fact in an application for payment of a health care 
benefit.  Because establishing probable cause requires 
sufficient evidence of all the elements of an offense, see 
Moran, 453 Mass. at 884, we first must consider whether there 
was probable cause that the defendants submitted false 
statements and, if so, whether they did so knowingly. 
i.  Probable cause that the defendants made false 
statements.  "False," in this context, means "wholly or 
partially false, fictitious, untrue, or deceptive."  See G. L. 
c. 175H, § 1.  According to the Commonwealth, there was probable 
cause to find that the defendants made false statements by 
submitting claims to insurance providers using billing codes 
indicating that the patients had been seen by a doctor.  We 
agree. 
Providers use a standardized system of procedure codes to 
classify the services provided to a patient when billing that 
patient's insurer.  See United States v. Singh, 390 F.3d 168, 
177 (2d Cir. 2004).  Federal cases enforcing similar false 
health care claim provisions have determined that the use of an 
improper procedure code can constitute a "false statement" where 
it results in a service provider seeking reimbursement at a 
greater rate than the provider otherwise would have.  See id. 
31 
 
 
at 177, 187-189 (evidence of health care fraud where doctor told 
nurse to bill her services using procedure codes that required 
doctor's involvement); United States v. Larm, 824 F.2d 780, 782-
783 (9th Cir. 1987), cert. denied, 484 U.S. 1078 (1988) 
(sufficient evidence of false statement where defendant used 
procedure code implying medical examination took place despite 
availability of code that more accurately captured minimal 
services actually provided). 
Here, the grand jury were not provided with an explanation 
of medical billing procedures.  They instead had two primary 
sources of information to use in determining whether the 
defendants made false statements:  patient records showing a 
billing entry on a date when Stirlacci was in Kentucky, and the 
trooper's testimony regarding the significance of those 
documents.27  We therefore consider whether the grand jury 
reasonably could have interpreted the patient billing records, 
with the aid of the trooper's testimony, as false. 
From the billing entries alone, the grand jury could have 
inferred that patients were billed for an office visit on a date 
when Stirlacci was in Kentucky, and that Stirlacci was listed as 
                     
 
27 For certain patients, there also were documents from the 
patients' insurance providers that presumably corroborated the 
data in the billing statement.  In most cases, however, these 
documents lacked sufficiently explicit links to the billing 
entries, and the State police trooper did not provide any 
detailed explanation of how to interpret them. 
32 
 
 
the service provider.  Absent more, however, this information 
would not amount to a false statement, because the grand jury 
also knew from the telephone calls that the renewals were issued 
to patients who visited the office, and that Stirlacci was the 
patients' doctor.  The Commonwealth provided no additional 
explanation of medical billing procedures that would have 
allowed the grand jury to determine that the billing entries 
falsely implied that Stirlacci was present. 
The grand jury, however, also could have relied on the 
trooper's assertion that the patients' billing records indicated 
that they had been seen by Stirlacci.  Although the judge 
correctly observed that the trooper did not consistently 
describe each patient's records as documenting a visit with 
Stirlacci, the trooper twice made more general statements that 
records for all the patients indicated that the patients had 
been billed for visits with Stirlacci. 
Thus, we conclude that the grand jury could have credited 
the trooper's testimony that billing entries in the patient 
records for the relevant time period implied Stirlacci's 
presence.  Upon reviewing the patient documentation that 
indicated billing entries on dates when Stirlacci was in 
Kentucky, the grand jury thereby could have inferred that the 
defendants made false statements.  We note, however, that the 
evidence submitted to the grand jury did not include billing 
33 
 
 
records for two patients;28 accordingly, there was insufficient 
evidence of a false statement for two of the twenty-two counts 
against each defendant.29 
ii.  Probable cause that the defendants acted knowingly.  
The Commonwealth also was required to establish probable cause 
that the defendants made the allegedly false statements 
"knowingly and willfully."  See G. L. c. 175H, § 2.  "A 
defendant's intent is 'not susceptible of proof by direct 
evidence, so resort is frequently made to proof by inference 
from all the facts and circumstances developed at trial'" 
(citation omitted).  Commonwealth v. Pike, 430 Mass. 317, 321 
(1999).  Prior cases in this area indicate that we can discern 
the requisite intent from deliberate misconduct. 
                     
 
28 The defendants' argument that the inability to 
differentiate between the defective indictments requires 
dismissal of all of the indictments, under Commonwealth v. 
Barbosa, 421 Mass. 547 (1995), is misplaced.  In that case, the 
grand jury returned a single indictment that could have applied 
to two different alleged instances of criminal conduct.  Id. 
at 550.  Here, the grand jury were presented with records for 
twenty-two patients and returned twenty-two indictments; there 
is thus no question as to which transactions the grand jury 
intended to indict.  The remaining question simply is which 
counts of the indictment match which patients, a determination 
that is largely an administrative matter. 
 
 
29 Exhibit no. 12 does not include any billing data.  
Exhibit no. 14 does not include any billing records; it does 
include what appears to be insurance documents indicating a 
payment, but the information is insufficient to link the payment 
to a specific patient. 
34 
 
 
In Pike, we affirmed a conviction of submitting false 
Medicaid claims where there was evidence that the defendant, who 
described himself as "the local drug pusher," id., "furnished 
prescriptions which he knew were illegal and would serve as the 
basis of claims for Medicaid payments."30  Id. at 322-323.  The 
deliberate violation of prescribing rules was sufficient to 
establish that the defendant acted "knowingly and willfully." 
Federal cases concerning similar false health care claim 
provisions further demonstrate that the fact that a falsehood 
stems from a deliberate violation of established rules can 
support the inference that the false statement was made 
knowingly.  See Singh, 390 F.3d at 177 (sufficient evidence of 
knowingly false statement where defendant was aware that his 
chosen billing code required physician's involvement based on 
explicit language on billing form); Larm, 824 F.2d at 782-783 
(sufficient evidence of knowingly false claim where defendant 
previously had been informed that he was using improper codes). 
Here, there was evidence that both defendants were aware 
that the nurse practitioner had told Miller that she should not 
be billing when patients had not been seen by a medical 
                     
 
30 The defendant in Commonwealth v. Pike, 430 Mass. 317, 322 
(2008), was convicted under G. L. c. 118E, § 40, which makes it 
a crime "knowingly and willfully [to make] or [cause to be made] 
any false statement" in connection with claims submitted to the 
Massachusetts Medicaid program. 
35 
 
 
professional, and yet decided to continue submitting claims.31  
In addition, Stirlacci's statement that the nurse practitioner 
did not understand that self-employed doctors had to operate by 
rules that were different from those for large medical practices 
also could support an inference that Stirlacci was aware that 
his and Miller's conduct was improper.32  Viewing the evidence in 
the light most favorable to the Commonwealth, we conclude that 
the grand jury reasonably could have inferred that the 
                     
 
31 The defendants at one point discussed the nurse 
practitioner's concerns: 
 
Miller:  "I'm billing and she's [criticizing] me for the 
way I'm billing. . . .  I'm trying to . . . bring us 
revenue." 
 
Stirlacci:  "Why is she [criticizing you for] billing?" 
 
Miller:  "Because I'm doing a 99213, and she's like, 'I 
didn't even touch the patient.  You can't do that. . . .' 
I'm like . . . [w]hy are you [criticizing me for a] med 
refill that I'm doing a 99213.  Let me do it.  I want to 
get money for these . . . patients." 
 
Stirlacci:  "All right . . . .  You know the standards to 
bill, okay?  And with patients coming in, yes.  So . . . 
just . . . do what you know is right . . . ." 
 
 
32 Discussing the nurse practitioner, Stirlacci said to 
Miller: 
 
"I don't understand her . . . .  [W]hen you're in the real 
world and you're trying to see patients and you're self-
employed . . . you make the rules according to what works 
for you and what works for the patient . . . .  I agree 
with some of her rules and regulations . . . , but other 
things . . . [are] not going to work because it's not good 
for business." 
36 
 
 
defendants were on notice that their billing practices falsely 
could imply services that were not rendered.  Moreover, the 
grand jury could have inferred from Stirlacci and Miller's 
conversations that they were sufficiently familiar with medical 
billing practices to know which billing codes were appropriate.33  
Therefore, the evidence presented, if not abundant, was 
sufficient to establish probable cause that the defendants each 
acted knowingly in making false statements.34 
In sum, the Commonwealth established probable cause that 
the defendants submitted false health care claims in violation 
of G. L. c. 175H, § 2, for twenty of the twenty-two counts 
against each defendant where the grand jury had documentation of 
a billing entry.  Because the individual indictments do not 
refer to the patients by name, the Commonwealth shall, as the 
judge previously ordered, submit a bill of particulars to 
                     
 
33 The grand jury had evidence that Stirlacci told Miller to 
"put in the 99212 . . . for the date that [patients] picked [the 
renewal prescriptions] up, because they didn't see the doctor, 
so it's down charged.  So, it's a 92 or a 93. . . .  Anything 
and everything you can get in, get in."  Although the grand jury 
did not have this information, apparently there is a separate 
code, 99211, that is appropriate to use when practitioners do 
not see patients.  See United States v. Singh, 390 F.3d 168, 177 
(2d Cir. 2004). 
 
 
34 Miller contends that, as an employee following orders, 
she could not have acted knowingly.  This, however, is 
contradicted by the evidence that Miller disregarded the nurse 
practitioner's concerns and expressed a determination to have 
claims reimbursed. 
37 
 
 
clarify which indictments require dismissal.  See Mass. R. Crim. 
P. 13 (b), as appearing in 442 Mass. 1516 (2004) (court may 
order prosecution to file bill of particulars on its own motion 
during time allotted for pretrial proceedings, or at any such 
time as judge may allow). 
3.  Conclusion.  There was sufficient evidence to indict 
Stirlacci for twenty-six counts of improper prescribing in 
violation of G. L. c. 94C, § 19 (a), and those counts should not 
have been dismissed.  All the counts against Miller under G. L. 
c. 94C, § 19 (a), shall be dismissed with prejudice.  The counts 
against both defendants for uttering false prescriptions under 
G. L. c. 94C, § 33 (b), shall be dismissed without prejudice.  
Finally, there was sufficient evidence to indict both defendants 
for twenty counts each of submitting false health care claims 
pursuant to G. L. c. 175H, § 2.  On remand, the Commonwealth 
shall submit a bill of particulars so that a Superior Court 
judge may determine which of the counts should be reinstated 
against both defendants, and which two counts must be dismissed 
without prejudice.  The matter is remanded to the Superior Court 
for further proceedings consistent with this opinion. 
 
 
 
 
 
 
 
So ordered.