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spoke to another physician who is licensed in New York that is very interested in telemedicine,” he wrote in one email to his main RX Limited contact, “Aaron Johnson.” “Please mention my name and tell him that I gave you his number.” Among the doctors he recommended was the friend who had given him a part-time job out of med school, a fellow Indian American named Anu Kon- akanchi. The two had met while Tumpati was a resident and grown close enough that Tumpati sometimes referred to her as “Akka,” a term meaning “older sister” in his native language of Telugu. She was reluctant to sign on at first, but Tumpati assured her that the network was legitimate, and she agreed that he could pass her information on to Johnson. When Johnson called her, he further reassured her that the company was on the up-and-up. Konakanchi, convinced, signed up and started filling out prescrip- tions. Soon she, too, was approving hundreds a day. She’d been struggling to make money in her solo practice, she said later. Now, she was suddenly receiving tens of thousands of dollars a month in wire transfers from the Hong Kong bank of a company called Southern Ace. “It helped with paying off my practice debts, my overhead, my malpractice, my expenses for having an office, staff,” she said. “For the first time, I was able to take some income for myself.”

Tumpati went on to recruit eight other physicians into the net- work. Through his connections in the Indian physician commu- nity, he knew doctors from all over the country. “The volumes were getting bigger and bigger,” he said. Tumpati didn’t oversee their work with RX Limited, for which they received $2 per pre- scription and he received a $1 referral fee. The setup was essen- tially what’s known as a multilevel marketing scheme. But instead of selling cosmetics or herbal supplements, the participants were prescribing painkillers by the thousands.

Unlike Tumpati, Charles Schultz wasn’t interested in suggesting improvements to the system he knew as AlphaNet. As far as the