Like many class-action settlements, the $3.5 billion payout announced in 1999 by the makers of the diet drug Fen-Phen unleashed a stampede of claims, including thousands that were bogus.
Many came courtesy of Dr. Abdur Razzak Tai, a Florida cardiologist who expected more than $1,000 from a plaintiffs' lawyer each time he certified a Fen-Phen patient with heart damage, a marker that often led to a six-figure payout.
Auditors later disqualified nearly 90 percent of Tai's certifications, and the FBI came knocking.
On Tuesday, a federal judge in Philadelphia sentenced Tai to six years in prison for fraud, brushing aside arguments that the 79-year-old doctor would almost certainly die there, and maybe soon.
"It's going to be a period of adjustment, just like for anyone who goes to prison," U.S. District Judge Juan R. Sanchez told him. "But that's something you brought upon yourself."
Tai, who lives outside Orlando, was far from the only professional nabbed for wrongdoing tied to the settlement by American Home Products, parent company of Fen-Phen manufacturer Wyeth. The multi-district litigation was consolidated and eventually settled in U.S. District Court in Philadelphia.
In 2005, a Texas doctor was sentenced to six months in federal prison for hiding hundreds of thousands of dollars in income she got for preparing echocardiograms for Fen-Phen plaintiffs lawyers. Two years later, the settlement trust sued a Missouri cardiologist for fraud, claiming she, too, had falsely certified thousands of medical reports for would-be plaintiffs.
Tai's case stood apart as much for the outcome as anything else.
His lawyer, Victor Martinez, told the judge that Tai for years seemed unable or unwilling to grasp the implications of the charges. When he was interviewed by FBI agents in 2006, Tai essentially confessed. But he repeatedly refused to plead guilty.
On the first day of his trial last September, Tai admitted to his lawyer that his hearing aid had malfunctioned and he didn't hear Martinez's opening argument. And when he took the stand in his own defense, he had little to offer jurors, except to suggest someone else forged his name on the reports.
Jurors needed only a few hours before they convicted him on all 13 counts of mail and wire fraud.
"I don't think there can be any question he was bewildered and befuddled and confused and not with it," Martinez told the judge.
Tai, a naturalized U.S. citizen of Pakistani descent, was educated in Pakistan and England before migrating to the United States more than three decades ago. He is married with children, but his family has largely abandoned him since his arrest, his lawyer said.
Federal guidelines recommended a sentence of at least 87 months for the crime. Martinez argued that would be tantamount to a death sentence, and pleaded for home confinement instead.
He called a Veterans Administration physician, Maria Colon, who spent nearly an hour outlining for the judge Tai's medical problems, from congestive heart disease to hearing loss and diabetes to "early dementia."
She guessed that Tai probably has two to three years to live, but said prison will almost certainly shorten that span. "The way I see it, he pretty much has nothing left," Colon told the judge.
For much of the hearing, Tai sat slumped in a chair at the defense table, bundled in a green wool fleece covering a black suit. When Sanchez gave him a chance to speak, the doctor ambled slowly to the middle of the courtroom, muttered "I just want to say I'm very sorry," and then sat down.
The prosecutor, Assistant U.S. Attorney Paul G. Shapiro, pointed out that Tai has been living and working with many of his medical ailments for years, and that he continued to see patients after the verdict, as he allegedly was deteriorating physically and mentally.
Some of Tai's patients, apparently unaware of his case, had appointments with him as recently this month, and were scheduled to return next month.
Shapiro noted that age, depression and even infirmity can't excuse Tai's crimes - and shouldn't be enough to spare him from punishment.
"He should be depressed," the prosecutor told the judge. "But that doesn't give him a get-out-of-jail free card."
How much Tai netted in the scheme was unclear, though Shapiro estimated it was millions of dollars.
The judge ordered him to pay $4.5 million in restitution. About half was based on claims that were paid out by the settlement trust and the rest on claims that were submitted but not paid because they were deemed to be invalid.
Tai pleaded with the judge to let him surrender to prison at a future date, vowing that he would not flee - or continue to practice medicine.
"Quite frankly, I cannot take that chance," Sanchez said. He ordered Marshals to take Tai into custody at once.