NEW YORK (AP) — A neurologist who already faces state rape charges in New York and New Jersey was arrested on federal charges Wednesday alleging he sexually abused pain management patients as he turned back rubs and hugs into gradually more invasive physical attacks.

An indictment unsealed in Manhattan federal court charged Ricardo Cruciani with sexually abusing multiple patients over 15 years, inducing them to travel across state lines to his offices in Manhattan, Philadelphia and Hopewell, New Jersey.

According to the indictment, Cruciani, 63, of Wynnewood, Pennsylvania met with victims alone in an examination room, his private medical office, in a hospital room, a hotel or an apartment outside of his medical offices.

Some pain patients were caressed as he prescribed significant quantities of opioids, according to the indictment. Once he’d developed a rapport, Cruciani would begin a pattern of sexual abuse of the victims, including intercourse, according to the court papers.

If certain victims refused or tried to refuse to engage in sex acts, he retaliated by referring them to another medical provider that would not prescribe the same combinations or quantities of narcotics as Cruciani prescribed, the indictment said.

“The alleged pattern of abuse in this case is outrageous,” said U.S. Attorney Damian Williams. “Doctors like the defendant take an oath to do no harm. It is difficult to imagine conduct more anathema to that oath than exploiting patients’ vulnerability in order to sexually abuse them.”

Prosecutors said Cruciani was expected to appear before a U.S. magistrate judge later Wednesday. He was arrested Wednesday morning in Pocono Pines, Pennsylvania.

A message for comment was sent to Cruciani’s attorney.

Cruciani was charged with five counts of enticing and inducing individuals to travel interstate to engage in illegal sexual activity. Each count carries a potential sentence of up to 20 years in prison.

The Ivy League-trained neurologist already faces criminal charges in state courts. He has pleaded not guilty and had remained free on $1 million bail.

Cruciani is also a defendant in pending state criminal cases in New York and New Jersey. Manhattan prosecutors charged him in May 2018 with 35 felony counts, including rape and aggravated sexual abuse. The cases have faced a series of continuances and delays. His next court appearance in Manhattan is scheduled for Dec. 9.

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Associated Press Writers Michael R. Sisak and Michael Rubinkam contributed to this report. Rubinkam reported from northeastern Pennsylvania.