If you think about it, what is a pill mill but a business hidden inside another business?

On the surface, it’s a medical clinic, a valuable resource, especially in poor and underserved communities. That could be an urban neighborhood, a rural town in coal country, or perhaps the only place to find medical care in a remote region of a vast Western state.

That’s the reason communities welcome and protect such ventures. It’s only later that the second level is uncovered. When it is, people tend to be shocked.

One business owner was asked what he thought was going on when people began lining up at the rear entrance to the clinic across the street from his store. Every morning at 6 AM, Monday through Saturday, rain or shine. His response: There sure were a lot of sick people in town. Good thing the clinic was there to help. Although the vehicles took up way too much parking space.

This level of naivete isn’t unusual. Most people don’t expect to have a criminal enterprise operating in public, under the guise of a community resource. The owners of such enterprises often go to lengths to portray themselves as a positive influence. It takes a while to figure out what’s really happening.

Of course, such clinics may also provide legitimate medical services. They treat patients, manage clinical cases, serve on staff at the hospital, donate generously to local causes– all the things good community clinics are supposed to do. But the real profit exists in a second business below the surface. Prescribing too many meds, ordering too many tests, submitting inflated bills, etc. There are many ways to exploit the current system, and plenty of incentive to do so.

It reminds me of the ‘skimmer’ devices that banks sometimes find attached to their ATM terminals. Usually a false keypad or reader designed to capture info such as a PIN during a debit card transaction. Once you have the PIN, the banking system opens up like a flower. A customer might not notice an unexplained charge on his monthly statement– made at a Big Box retailer in a distant town he’s never even visited. Much of the merchandise will be shipped overseas for resale at inflated prices.

In a way, the pill mill is just an illegal skimmer on the healthcare system. Patients are viewed as revenue centers. The path to profit is through overprescribing.

Of course, some legal businesses are much the same. But that’s a whole other discussion.