Joan Rubinger overcame a catastrophic biking accident that left her paralyzed to become an influential pain-relief specialist helping top-tier athletes return to the field after acute and chronic injuries.

Her website describes a client list that includes 169 NFL Pro Bowl selections, 29 NBA and WNBA champions, and 15 Olympic medalists. Among her most notable patients were NBA All-Stars Kobe Bryant and Dwyane Wade, as well as MLB All-Star Fernando Tatis Jr.

But behind the scenes, the U.S. Drug Enforcement Administration alleged in court filings that Rubinger distributed thousands of illegal prescriptions for highly addictive painkillers in a “covert and slinking” scheme that she likened to selling hamburgers at a fast-food restaurant. Over a four-year period, federal authorities said, she prescribed 260,000 pills containing controlled substances to patients in more than 20 states.

Citing what an administrative law judge called egregious conduct, the DEA last month revoked Rubinger’s authority to prescribe opioids. That action followed Rubinger’s agreement in March to pay $1.4 million to settle a parallel Justice Department civil complaint that accused her of dispensing controlled substances such as oxycodone, Percocet and Xanax on hundreds of occasions without any legitimate medical purpose. Oxycodone and Percocet are Schedule II opioids, the most tightly restricted category of drugs that can legally be prescribed, while Xanax, a benzodiazepine, is a Schedule IV controlled substance; writing prescriptions for any of them requires a federal DEA registration, the credential the agency revoked last month. Rubinger did not admit wrongdoing in the settlement and agreed never again to prescribe controlled substances.

While authorities announced the settlement earlier this year, federal court papers unsealed at the request of The Associated Press provide new details about a medical provider whom the DEA says enriched herself while putting patients’ health at risk.

The DEA alleged in a seizure warrant that the scheme expanded over the years “from professional athletes” to a wide range of other clients, including members of an Ohio-based street gang, a confessed New Jersey drug trafficker and a New York City model. Federal authorities also alleged that Rubinger took steps to avoid DEA scrutiny, coaching clients through an encrypted messaging app on how to keep their prescriptions from being flagged by pharmacies.

The DEA described how two former athletes received illicit prescriptions from Rubinger, including former All-Pro Carolina Panthers linebacker Thomas Davis, whose wife alerted the agency to Rubinger’s activities, according to the court records and an interview with Davis’ now ex-spouse.

Rubinger began prescribing Davis opioids while he was moving between teams before retiring after the 2020 season, according to his wife. In total, authorities alleged, he received more than 13,000 oxycodone and Percocet pills between November 2019 and March 2024.

Davis did not respond to requests for comment, and no one answered his door in North Carolina when an AP reporter visited.

The DEA also identified another former reserve NBA guard who, along with his wife, paid Rubinger more than $50,000 for illicit prescriptions long after he left the league. He could not be reached for comment.

Rubinger’s spokesman, Erick Mullen, declined to answer questions about her treatment of Davis or any other athlete, citing medical privacy laws.

“Joan’s case was not a criminal matter but a civil action,” he wrote in an email. “No raids with blue windbreakers carrying agency initials, and no loss of liberty at stake.”

He said no administrative or disciplinary actions had been taken by nursing boards in California and New York, where she is licensed. Her DEA registration was a federal credential, but the authority to license and discipline nurse practitioners rests with state boards, which act separately from federal authorities.

Mullen also did not address AP’s questions about Rubinger’s alleged ties to the Ohio-based Loyal to Brothers street gang, but suggested the allegations reflected “actual harm” to his client. “You’ll have to imagine what kind of people threatened, intimidated, bullied and cajoled a paraplegic nurse practitioner and single mother into this kind of situation,” he wrote.

Federal prosecutors declined to comment on why they did not pursue criminal charges, even as they accused Rubinger in court filings of violating federal drug statutes and regulations 900 times.

James Rafalski, a retired DEA investigator, said he worked many cases that ended in criminal charges and involved far larger quantities of pills. But Rubinger’s conduct stood out as especially flagrant, he said, and he was surprised it did not lead to a criminal prosecution.

“Most doctors who abuse their DEA registration just write scripts without a thorough examination of the patient,” said Rafalski, who reviewed court records in the case. “She knowingly took steps to evade detection by the DEA and instructed her clients to do the same.”

Prosecutors consider a range of factors when deciding whether to bring criminal charges, from the strength of the evidence to how a jury is likely to view a defendant.

Eric Grant, the U.S. attorney in Sacramento, said in a statement to AP that “the significant financial penalty” and the ban on Rubinger prescribing controlled substances “grants the public meaningful protections against the unlawful dispensing of dangerous drugs.”

Like many of her clients, Rubinger, 49, was once an elite athlete herself. As a child, she competed internationally in gymnastics. Later, she rowed and pole vaulted at Syracuse University.

After graduating, she coached women’s rowing at Indiana University, worked alongside elite NBA trainers and assisted China’s Olympic volleyball team.

“My sculpted physique and bronzed, sun kissed skin were fruits of very hard labor,” she wrote in a personal blog. “Earned. Day after pavement-pounding day.”

She started All Pro Sports Medicine around 2010, describing it as a niche service that offered athletes discreet medical attention at all hours. In 2014, she became licensed as a nurse practitioner in California, which would have allowed her to prescribe medication.

Justice Department lawyers described her practice as “highly unorthodox” because it often operated out of hotel rooms without medical records or a physician’s supervision.

Rubinger filled her website and social media accounts with testimonials from athletes praising her sports medicine work. Among those she featured were the NFL’s Drew Brees and Saquon Barkley, the NBA’s Wade and Bryant, and Major League Baseball’s Manny Machado. There is no suggestion in court records that Brees, Barkley, Bryant, Machado or Wade committed any wrongdoing or were aware of Rubinger’s alleged prescription practices. Their statements of support all predated the Justice Department complaint. Representatives for the athletes did not respond to requests for comment. Bryant died in a helicopter crash in 2020.

Tatis, a teammate of Machado’s on the San Diego Padres, confirmed that he had also been a client of Rubinger but said he did not know she had been accused of issuing illicit prescriptions.

“We were always clear on what I wanted,” he told AP. “It was hydration and stuff to keep me on the field, and we were really professional and it was really clear on my side.”

The attention around Rubinger’s practice stemmed in part from “The Goo,” a pain-relieving gel she created. She marketed it as a “wonder cream” and “Pro Athletes’ Best Kept Secret.” It contains the same active ingredients found in over-the-counter pain-relief gels such as Bengay.

“I could literally submerge my whole body in a bathtub of Goo, man,” Davis said in a 2022 video promoting the treatment.

Rubinger’s life nearly ended in tragedy in 2015, when she fell 20 feet over the edge of a cliff while mountain biking. The crash broke more than a dozen ribs, punctured her lungs and left her with spinal cord injuries that confined her to a wheelchair.

“I don’t know who I am anymore,” she wrote in the blog chronicling her recovery. “I’ve lost my identity. It terrifies me.”

She initially struggled with simple tasks such as brushing her teeth. Still, she returned to work within three months. After her comeback, several NBA players, including Wade, wore orange wristbands in her honor on the court.

“You would look at Joan sitting quietly in her wheelchair and never know that she is the secret weapon behind the best athletes in the world,” Atlanta Hawks guard Buddy Hield wrote in one of several testimonials on her company’s website.

Hield did not respond to requests for comment made through the Hawks.

The DEA alleged that Rubinger went to great lengths to conceal the operation.

New clients had to follow specific steps laid out in a document she called “THE RULES,” court records show, and she threatened to cut off anyone who slipped up.

“I put these rules in place for a reason: to minimize the attention we attract from the DEA,” she told one prospective client, according to the seizure affidavit, which allowed agents to confiscate nearly $170,000 in what it described as “crime proceeds” from her bank account.

Investigators said Rubinger collected hundreds of thousands of dollars through a digital money transfer app in exchange for prescriptions for painkillers. She required payment up front, the DEA said, and distributed a price list for the drugs.

Getting a prescription, she told clients in “The Rules,” was “like at McDonald’s, you gotta pay for your burger before they hand it to you.”

In early 2024, the DEA said it inspected a Stockton, California, doctor’s office where Rubinger had registered her practice. The office belonged to an orthopedic surgeon Rubinger had shadowed years earlier. The surgeon told authorities he had no role supervising her work and no knowledge of her prolific prescribing, according to the DEA order revoking her prescribing registration.

Many states, including California, require nurse practitioners in most circumstances to work under a physician’s supervision when prescribing opioids.

In social media posts, Rubinger and her athlete clients regularly refer to her as “Dr. Joan.” Nurse practitioners, however, are not doctors.

Her website says she holds a Ph.D., and her LinkedIn profile lists an unspecified “doctoral degree” from the Ohio State University. A university spokesperson said Ohio State has no record of Rubinger attending or working there. Mullen did not answer questions about her graduate studies.

Rubinger holds master’s degrees in nursing and kinesiology from Indiana University and The George Washington University.

The DEA began investigating Rubinger in 2022 after a tip from Davis’ wife.

Kelly Davis told authorities and the AP that she went to an emergency room in 2022 near her home in Charlotte, North Carolina, complaining of chest pains. While she was being evaluated, a doctor told her she had been flagged for receiving excessive pain medication prescriptions.

Without her knowledge, Rubinger had written 23 oxycodone prescriptions for her husband over two years listing Kelly Davis as the patient, according to the DEA and Kelly Davis.

In court documents, the DEA said Rubinger took such steps with her clients “to obscure her excessive prescribing and avoid law enforcement detection.”

“These individuals are not the intended recipients of the prescriptions, often do not even know they are being prescribed controlled substances,” the DEA wrote, “and have not been examined by Rubinger, much less have an established doctor-patient relationship with her.”

Kelly Davis said she was stunned and immediately confronted Rubinger through Instagram.

“This is insane,” the football player’s wife wrote, according to the DEA’s revocation order. “You clearly know he has a problem. Why would you do this?”

She said Rubinger was well liked by players and recalled running into another professional athlete the one time she met Rubinger, while accompanying her husband to a 2020 appointment at a Marriott in Charlotte.

The NFL has well-documented issues with painkillers. They unfolded against a national opioid crisis that federal health officials have linked to hundreds of thousands of overdose deaths since the late 1990s. A 2011 study found that 52% of the league’s retired players used opioids during their careers. More recently, a 2020 investigation found that the head trainer for the Washington Commanders illegally distributed oxycodone to players. The trainer accepted a $10,000 fine under a Justice Department deal to avoid prosecution if he stayed out of trouble. An attorney for the trainer declined to comment.

The NFL has since adopted more detailed accounting of drug prescriptions. Players may seek medical care outside their teams, though since 2019 they have been required to report any prescriptions they receive elsewhere.

Shortly after reporting Rubinger to the DEA, Kelly Davis shared her suspicions with the NFL Players Association and the California Board of Registered Nursing. The Players Association declined to comment; the NFL said it had no awareness of Rubinger; and the California nursing board said it does not discuss disciplinary actions until they are finalized.

Kelly Davis said her husband’s opioid use contributed to the collapse of their marriage. The couple divorced last year.

In a May interview on The Pivot Podcast, Davis said his opioid abuse wrecked his home life.

“There’s a lot of shame and guilt,” he said, holding back tears. “I’ve always been a person and a player that said that I would never allow anything to control me.”

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Goodman reported from Miami, and Pells from Denver. Associated Press journalists Brett Martel in New Orleans, Rob Maaddi in Tampa and Michael Reo in Washington contributed reporting. Retired AP reporter Bernie Wilson contributed reporting from San Diego.

This story was originally featured on Fortune.com