When you see 50 people standing outside a clinic waiting for their prescriptions, you can pretty much guess there’s something up.

That’s what detectives from the Sheriff’s Major Crimes HALT unit found Tuesday morning when they visited a clinic in Sylmar.

“These are what we call pill mills,” explained Sgt. Steve Opferman, spokesman for the team. “They appear to be medical clinics when in fact, they are where people go to get controlled substances.”

HALT – an acronym for Health Authority Law Enforcement Task Force – was tipped off to four “pill mill” locations after the February 15 arrest of Michael Lyadda in Valencia.

On that date, Lyadda, a “recruiter” for the pill mill operation, led detectives throughout the Santa Clarita Valley to various pharmacies where pills were obtained and 12 accomplices were arrested. (Read the original story here.)

During the investigation of Lyadda’s case, detectives found prescription pads from the locations raided today. Search warrants were served at three clinic locations: one in 13000 block of Foothill Blvd. in Sylmar, another in the 5600 block of Pico Boulevard in Los Angeles and the last in the 4300 block of Sunset Boulevard in Los Angeles.

At the last location, the clinic staff were using prescription pads signed by a doctor that died January 29.

“We had hoped to arrest some doctors,” Opferman said. “They have doctors on the payroll who pre-sign the prescriptions.”

He said that they interviewed the 50 people who were hoping to pick up slips that would allow them to get controlled substances such as oxycodone from the pharmacy.

“This is all tied into insurance and Medi-cal fraud,” he said. “These recruiters find elderly people with Medi-cal, they take them to the pharmacy and give them the money for their prescription, then when they get the pills, buy them for an additional $100 or so. They can sell that on the street for another $2,000. You can make a lot of money doing this.”

“The majority of patients aren’t really patients,” Opferman continued. “At the Sylmar clinic, there were no employees, just a receptionist taking names and preparing charts for people waiting. But when you see 50 people in line, you know something’s not right. There’s no doctor that can see 50 patients in one day.”

Opferman said that the recruiters tell the “patients” to complain of back pain so they can get the oxycodone, which legitimate doctors won’t prescribe until the patient’s condition is much more severe.

“They don’t do any type of medical exam whatsoever,” he said. “Usually to get what they’re getting, they have to build up a tolerance, have major surgery or be dying of cancer. But it’s part of the scam. If they have Medicare Part D, it pays for prescriptions. If the recruiter gets a bottle of 90 oxycodone pills, that’s good for $2,000 on the street.”

Lyadda was one of those recruiters.

“The Santa Clarita station had him under surveillance and watched him recruit patients,” Opferman said. “When they served the search warrants, they found he had $140,000 in cash and a bunch of IDs. We talked to some of the people he recruited and found prescription pads from four clinics. We served search warrants for three of those today.”

During the service, Opferman said that they arrested a male suspect with a history of health care and prescription fraud in Utah, Nevada and California.

“He’s being booked on suspicion of health care and prescription fraud here, but he’ll probably be released for investigation,” he explained. “We have a ton of evidence to go through, lots of prescription pads, thousands of phony patient records and a lot of notes.”

Opferman said that they also confiscated ledger books with the names of the recruiters, their patients and how much they got paid by the clinic.

The bottom line of today’s activity: find the two living doctors whose names appear on the signature line of the prescription pads. Next are the clinic managers, the people who set up the clinics.

“Once we get the doctors, they have to go through the Medical Board, the Drug Enforcement Administration and us,” Opferman said. “But this is actually just the beginning of the investigation. This has become an epidemic in LA.”

Opferman said that the pill mills started in Appalachia, then moved operations to Miami, then west to Los Angeles.

“We’ll shut down one, then three more open up. It’s hard to keep up with the proliferation. We probably have 100 locations on our waiting list (for warrants). Every day, we find out about new ones. Sometime we don’t even get to them before they close and resurface in another area. We can only do so many at a time.”