A Montgomery, Alabama, physician and three nurse practitioners were arrested yesterday following their indictment by a federal grand jury for their role in the operation of a pill mill run from the offices of Family Practice, a Montgomery-based medical clinic.

The arrests follow last week’s guilty plea of Family Practice’s owner, Dr. Gilberto Sanchez, to charges of drug distribution, health care fraud, and money laundering.

Collectively Dr. Julio Delgado, along with nurse practitioners Lillian Akwuba, Steven Cox, and Elizabeth Cronier, face 87 combined counts in what is described as the largest pill mill operation in Alabama’s Middle District.

The indictments charge that the conspirators prescribed medications including fentanyl, hydrocodone, oxycodone, methadone, and alprazolam, among others, for no legitimate medical purpose—helping to fuel the opioid epidemic and defrauding a number of state and federal health care programs and private insurers. The indictment also indicates that the defendants further defrauded the healthcare programs by ordering unnecessary tests and procedures and diagnosing patients with vague and unsubstantiated medical conditions. Some patients were required to visit the office monthly to renew the illegitimate prescriptions.

The defendants’ fraudulent activities were lucrative, with court documents indicating that the practice netted gross receipts of more than $3 million per year since 2014.

The charges, including conspiracy to distribute controlled substances, aiding and abetting health care fraud, and money laundering, bring with them sentences of 10-20 years upon conviction along with the probability of substantial fines and other monetary penalties.