A Derby nurse who admitted taking kickbacks from a drug company that makes the powerful opioid painkiller Subsys is cooperating with federal investigators, who recently charged two drug company employees with violating kickback laws, court documents show.
Documents filed earlier this year show that Heather Alfonso, a nurse formerly employed by a Derby pain clinic, requested a delay in sentencing because she was “actively cooperating in an ongoing investigation in several jurisdictions, including Connecticut,” in which arrests were expected.
“Ms. Alfonso’s cooperation with both state and federal investigations is significant when qualifying her character and conduct, relative to sentencing,” her attorney said in filings in U.S. District Court in Hartford. A judge agreed to delay Alfonso’s sentencing until Sept. 13.
Alfonso, of Middlebury, pleaded guilty last June to receiving $83,000 in kickbacks from Arizona-based Insys Therapeutics from January 2013 to March 2015, while she was employed by the Comprehensive Pain and Headache Treatment Center. She was among the highest prescribers in the country of the company’s potent drug, Subsys, writing out prescriptions at what prosecutors called “an alarming rate,” in exchange for payments made through the company’s sham “speaker’s program.”
Earlier this month, the U.S. Attorney’s Office for the Southern District of New York charged a former district manager for Insys, Jonathan Roper, and a former sales representative, Fernando Serrano, with violating anti-kickback laws by allegedly paying doctors to participate in “phony educational programs” designed to boost prescriptions of a “fentanyl-based sublingual spray,” which describes Subsys.
In the indictment, federal prosecutors said doctors were paid as much as $3,000 per “speaking” engagement to attend dinners at high-end restaurants in Manhattan that involved no education at all. Doctors were selected as speakers “in order to induce (them) to prescribe large quantities of the fentanyl spray.”
The indictment includes a 2014 email by Roper to his sales team, in which he expresses displeasure that certain doctors were not prescribing enough Subsys.
“We invest a lot of time, $, blood, sweat, and tears on ‘our guys’… We hire only the best of the best to be a part of our speaker bureau and dropping script counts is what we get in return?
“This is a slap in the face to all of you and is a good indication as to why NONE of you are climbing in the rankings this quarter.”
In announcing the arrests, Manhattan U.S. Attorney Preet Bharara said that fentanyl “is an incredibly dangerous and highly addictive drug that is finding its way into, and destroying, too many lives in our communities.”
Despite tight restrictions on the drug, including that it be used only for cancer patients, Insys reported $330 million in net revenue from Subsys in 2015.
Alfonso admitted in court that Insys paid her about $1,000 per event, through the speaker’s program, to go out to dinner with friends and co-workers, or with just an Insys sales rep. She is no longer practicing medicine, and no other clinicians at the Derby pain center have been charged.
Alfonso was among the highest prescribers of Subsys in the country from 2013 to 2015. Medicare and private insurers paid out about $1.6 million for the prescriptions she wrote while she was receiving kickbacks from Insys, court records say.
Previous C-HIT stories identified Alfonso as the state’s top Medicare program prescriber of potent narcotics, including fentanyl, in 2013.
Nationally, Insys paid out about $10 million to more than 3,000 physicians in 2013 and 2014, most of it for speaking engagements, federal records show. A C-HIT story last July found that eight of the top 10 prescribers of Subsys were paid more than $870,000 in speaking fees by the drug maker in 2013 and 2014.
Insys has previously denied any wrongdoing in its marketing of Subsys.