Florida and Tennessee Pain Clinic Owner Extradited from Italy to the United States to Face RICO Charges


A dual U.S.-Italian national was extradited from Italy to the United States on Nov. 20.  The U.S. Marshals Service effectuated the transportation of the defendant from Lamezia Terme, Calabria to Knoxville, Tennessee. 

Luigi Palma, 54, is a co-defendant of Sylvia Hofstetter, who, along with three medical providers, was convicted of numerous charges related to “pill mill” operations in Florida and Tennessee following a four-month trial earlier this year in Knoxville.  Palma contested his extradition from Italy for approximately two years.  The charges against Palma are varied, and reflect his alleged role in owning and operating pain clinics in South Florida and the Knoxville area over the course of several years.   Included in those charges are a Racketeer Influenced and Corrupt Organization (RICO) conspiracy and a conspiracy to distribute oxycodone, oxymorphone, and morphine outside the scope of professional practice and not for a legitimate medical purpose.

Palma appeared before U.S. Magistrate Judge Debra C. Poplin in the Eastern District of Tennessee earlier today and entered a not-guilty plea to all charges.  Palma waived his immediate right to a detention hearing and remains in the custody of the U.S. Marshals Service.  Trial has been set for March 30, 2021, before U.S. District Judge Thomas A. Varlan. 

This sweeping prosecution, which has resulted in approximately 140 convictions so far, is the result of an investigation by the U.S. Attorney’s Office for the Eastern District of Tennessee, the Criminal Division’s Organized Crime and Gang Section, and the FBI High Intensity Drug Trafficking Area, comprised of investigators assigned to the task force by the Loudon County Sheriff’s Office, Knoxville Police Department, Blount County Sheriff’s Office, Roane County Sheriff’s Office, Harriman Police Department, and Clinton Police Department. 

Other agencies provided invaluable assistance, including the Rome Attaché of the Justice Department’s Office of International Affairs; FBI’s liaison in Rome; FBI’s Miami Field Office; the Hollywood, Florida, Police Department; the U.S. Department of Health and Human Services; the Tennessee Department of Health; and the U.S. Drug Enforcement Administration’s Knoxville Diversion Group.  The Justice Department’s Office of International Affairs and FBI’s liaison in Rome were particularly instrumental in effectuating Palma’s extradition, as were Italian law enforcement agencies and prosecutors, including the Italian Ministry of Justice, Carabinieri Raggruppamento Operativo Speciale (ROS), and Interpol-Rome.  The United States is particularly appreciative of their assistance.

The extradition of Palma was made possible by provisions of a treaty between the United States and Italy.  The United States is grateful to the Italian authorities for their robust cooperation in this matter.

An indictment is merely an accusation.  A defendant is presumed innocent until proven guilty beyond a reasonable doubt in a court of law.

Assistant U.S. Attorney Tracy L. Stone and Deputy Chief Attorney Kelly Pearson and Trial Attorney Damare Theriot of the Criminal Division’s Organized Crime and Gang Section represent the United States in the prosecution of this case.

The year 2020 marks the 150th anniversary of the Department of Justice.  Learn more about the history of our agency at www.Justice.gov/Celebrating150Years.

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