Cerebral and Done proved that telehealth's prescribing incentive structure rewards overprescription -- and the DEA fined them only $3.6M

In November 2024, the Department of Justice and DEA announced that Cerebral, a telehealth mental health company, would pay $3.6 million for allegedly using financial incentives to pressure providers into prescribing more Adderall and other controlled stimulants. Internal documents revealed the company tracked prescribing metrics, considered disciplinary measures for providers who did not prescribe enough, and explicitly tied stimulant prescriptions to patient retention and revenue. Separately, DOJ brought criminal charges against Done executives for similar practices -- insufficient clinical supervision, inadequate ADHD diagnostic processes, and a business model that treated prescriptions as a conversion metric. These were not outliers. They were the logical endpoint of a business model where patient acquisition cost is high, retention depends on medication access, and the prescriber is a contractor paid per visit. The real harm is not abstract regulatory concern -- it is concrete patient injury. Patients who received inappropriate ADHD diagnoses and stimulant prescriptions through these platforms now face two problems: those who genuinely have ADHD now face heightened skepticism from new providers suspicious of telehealth diagnoses, and those who were incorrectly prescribed stimulants may have developed physiological dependence. Research shows that receiving an initial stimulant prescription via telehealth may signal increased risk of subsequent stimulant use disorder. Meanwhile, the $3.6M fine against a company that raised over $300M in venture capital is not a deterrent -- it is a cost of doing business. The fine amounts to roughly $0.50 per prescription potentially affected. This problem persists because the venture-backed telehealth model is structurally misaligned with clinical care. These companies raise capital on growth metrics -- monthly active patients, prescription fill rates, revenue per patient -- and the fastest way to grow these metrics is to make prescriptions easy to obtain. The DEA's temporary telemedicine flexibilities removed the in-person evaluation requirement that historically served as a guardrail against rushed prescribing. Without that in-person friction, the only remaining check is the individual clinician's judgment, which is systematically undermined when the clinician is a 1099 contractor whose income depends on patient volume and whose employer tracks prescribing rates.