Case Against Derby Nurse Involves Potent Painkiller

Federal charges against Derby nurse Heather Alfonso center on a powerful and addictive painkiller called Subsys, which has been heavily marketed by the Arizona-based manufacturer Insys Therapeutics, federal officials confirmed Wednesday.

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 a 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 prosecuting the case. Receiving kickbacks in exchange for billing charges to a federal health care program is illegal.

While the company and drug are not named in the indictment, a prosecutor revealed in court Tuesday that the case involves Subsys and Insys Therapeutics.

Prescribing records from the federal Medicare program in 2013 show Alfonso was among the 10 highest prescribers – nationally — of Subsys, which contains fentanyl, a powerful narcotic. Medicare data shows she wrote 69 prescriptions, at a total cost of $239,224, in 2013. The Food and Drug Administration approved Subsys only for cancer patients, but the federal indictment says Alfonso gave it to patients with chronic pain who did not have cancer.

Alfonso, who was an advanced practice registered nurse (APRN) at the Comprehensive Pain and Headache Treatment Center, located in Derby, wrote about $1.6 million in prescriptions for Subsys for patients on Medicare, Medicaid and private insurance from 2013 to 2015, according to the U.S. attorney’s office. The bulk of the charges were billed to Medicare.

At the same time, Insys paid Alfonso as a speaker for more than 70 “dinner programs,” at a rate of approximately $1,000 per event, the U.S. attorney’s investigation found. In many instances, the dinner programs were attended only by Alfonso and a sales representative for the drug manufacture; in other instances, Alfonso’s office staff and friends, who did not have licenses to prescribe controlled substances, attended.

“For the majority of these dinner programs, Alfonso did not give any kind of presentation about the drug at all,” the U.S. attorney’s office said.

Heather Alfonso

Alfonso could not be reached for comment. Messages left with Insys were not returned. The company previously has denied any wrongdoing in its marketing of Subsys.

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.  Alfonso’s sentencing is set for September.

In the last two years, several physicians who have received speaking fees from Insys have been disciplined or arrested for improperly prescribing Subsys. Dr. Gavin Awerbuch, a Michigan neurologist who was paid speaker’s fees by Insys, was arrested last year after federal prosecutors said he defrauded Medicare of $7 million and improperly prescribed Subsys to patients. Another top Insys speaker, Dr. Jerrold Rosenberg of Rhode Island, was reprimanded last September for inappropriately prescribing Subsys and other painkillers.

Alfonso 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 Schedule II prescribers in the country in 2012 and was the highest prescriber in Connecticut in 2013, writing $2.7 million in prescriptions.

Earlier this year, a probe by the Drug Control Division of the Department of Consumer Protection led Alfonso to surrender her state and federal licenses to prescribe controlled substances. She has since left the pain center, a spokeswoman there has said. Her nursing license is now under investigation by the state Department of Public Health.

C-HIT data specialist Grant Smith contributed to this report.