A Derby nurse practitioner identified as the state’s highest Medicare prescriber of potent narcotics has admitted taking kickbacks from a drug company in exchange for prescribing pain medication.
Heather Alfonso, 42, of Middlebury, pleaded guilty Tuesday in U.S District Court in Hartford to receiving $83,000 in kickbacks from January 2013 until March 2015 from an unnamed pharmaceutical company that makes a drug used to treat cancer pain.
In pleading guilty, Alfonso admitted that the money she was paid influenced her prescribing of the drug, according to the U.S. Attorney’s Office for Connecticut, which is handling the case.
The charge of receipt of kickbacks in relation to a federal healthcare program carries a maximum term of imprisonment of five years and a fine of up to $250,000. U.S. District Judge Michael P. Shea scheduled sentencing for Sept. 17, 2015.
Alfonso, an advanced practice registered nurse (APRN) at the Comprehensive Pain and Headache Treatment Center, located in Derby, was identified in recent C-HIT stories as the state’s highest Medicare program prescriber of Schedule II drugs – potent narcotics with a high potential for addiction and abuse. She was among the top 10 prescribers in the country in 2012 and was the highest prescriber in Connecticut in 2013, writing $2.7 million in prescriptions.
Her prescribing habits in 2012 and 2013 did not appear to attract scrutiny until earlier this year, when a probe by the Drug Control Division of the Department of Consumer Protection led her to surrender her state and federal licenses to prescribe controlled substances. She has since left the pain center, a spokeswoman there said. Her nursing license is now under investigation by the state Department of Public Health.
Neither Alfonso nor Dr. Mark Thimineur, an anesthesiologist who is medical director of the Derby pain center, could be reached for comment Tuesday evening.
According to the U.S. attorney’s office, Alfonso prescribed an array of controlled substances to clients of the treatment center and was a “heavy prescriber” of a drug used to treat cancer pain, racking up more than $1 million in Medicare claims for that drug alone. Interviews with several of her patients, who are Medicare Part D beneficiaries and who were prescribed the drug, revealed that most of them did not have cancer, but were taking the drug to treat chronic pain, the U.S. attorney’s office said. Medicare and most private insurers will not pay for the drug unless the patient has an active cancer diagnosis and an explanation that the drug is needed to manage the patient’s cancer pain.
The U.S. attorney’s investigation revealed that the manufacturer of the drug paid Alfonso as a speaker for more than 70 “dinner programs,” at a rate of approximately $1,000 per event.
“In many instances, the dinner programs were only attended by Alfonso and a sales representative for the drug manufacturer,” according to a statement from U.S. Attorney Deirdre M. Daly’s office. “In other instances, the programs were attended by individuals, including office staff and friends, who did not have licenses to prescribe controlled substances. For the majority of these dinner programs, Alfonso did not give any kind of presentation about the drug at all.”
Daly said the investigation by her office is ongoing. The U.S. Department of Health and Human Services Office of the Inspector General, the Federal Bureau of Investigation, and the Drug Enforcement Administration are assisting in the probe.
Payment records compiled by the news organization ProPublica show that Alfonso received multiple payments for consulting and speaking from the drug company Cephalon, now owned by Teva Pharmaceuticals, in 2012 and 2013. Those records do not extend past 2013, however, so it is not known which drug company is involved in the federal charges. ProPublica does not list any other drug company payments to Alfonso.
Alfonso was a high prescriber of a number of painkillers used on cancer patients in 2012 and 2013, including the drug fentanyl. She wrote 782 prescriptions for fentanyl in 2013 alone – more than twice the number of the next highest prescriber.
Alfonso came to the attention of state medical regulators last summer, when she was reprimanded by the Board of Examiners for Nursing for providing narcotic pain medications to a patient seven times without personally examining the patient, instead “inappropriately” relying on an unlicensed assistant, state records say. She paid a $2,000 fine and took courses in safe prescribing and delegating work duties, but was allowed to continuing practicing without restrictions.