Drug Company Falsely Claimed Patients Had Cancer, Feds Allege

 A former executive of Insys Therapeutics has been criminally charged for leading a special “reimbursement unit” at the company that defrauded insurers into paying for a potent opioid pain medication by falsely claiming patients had cancer and other conditions needed for pre-approval. Elizabeth Gurrieri, a former manager of reimbursement services for Arizona-based Insys, was charged with wire fraud conspiracy in a criminal complaint filed in federal court in Boston. The complaint sheds light on a Connecticut case involving a Derby nurse who has been charged with taking kickbacks from Insys in exchange for prescribing the company’s fentanyl spray, Subsys. The nurse, Heather Alfonso, has been cooperating with investigators in Boston and Connecticut in an ongoing probe of Insys’ sales tactics. The complaint against Gurrieri notes that patients needed prior authorizations from insurance companies to cover the costs of Subsys, an expensive drug approved by the Food and Drug Administration in 2012 for the management of breakthrough pain in patients with cancer who already were receiving opioid pain treatment.

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Desperate Choices: Giving Up Custody For Care

Ten years have gone by, but Lisa Vincent and her son, Jose, flash back to their goodbye with fresh anguish and faltering voices. He is 21 now, but the 11-year-old boy he was back then easily re-surfaces, all anger and confusion. “I didn’t understand. I was under the assumption I was going back to her,” Jose says. “For a long time, I felt that whole ‘she gave up on me like everyone else did.’ Now, I realize it wasn’t her.

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Insys Sales Manager Charged In Kickback Scheme

Fifteen months after a Derby nurse admitted taking drug-company kickbacks in exchange for prescribing a powerful opioid painkiller, a former district sales manager for the company was arrested Thursday on federal charges that he helped to orchestrate the kickback scheme. Jeffrey Pearlman, of Edgewood, NJ, who was district sales manager for the New York region for Insys Therapeutics through 2015, and the sales representatives he managed “induced certain physicians, advanced practice registered nurses (APRNs) and physician assistants to prescribe the pharmaceutical company’s fentanyl spray by paying them to participate in hundreds of sham ‘Speaker Programs,’” according to a release from the U.S Attorney’s Office for Connecticut. The scheme “defrauded federal healthcare programs” of millions of dollars that was paid out improperly for the drug, Subsys, which is approved for use only in cancer patients with breakthrough pain. Federal prosecutors allege that Pearlman “personally profited” from the scheme through inflated quarterly bonuses he received that were based, in large part, on the sales results of the employees he managed. Pearlman, who is no longer employed by Insys, could not be reached for comment Thursday.

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Derby Pain Clinic’s High Prescribing Of Cancer Drug Extends Beyond Nurse

Four nurses, all of them affiliated with a Derby pain clinic, were responsible for nearly all of the state’s 2014 Medicare spending on the powerful opioid painkiller Subsys, which is at the center of a kickback probe. New Medicare data for 2014 show the four nurses, all who worked at the Comprehensive Pain and Headache Treatment Center of Derby, were responsible for 279 claims for Subsys, at a cost of $2.3 million. The highest prescriber was Heather Alfonso, an advanced practice registered nurse (APRN) formerly employed by the clinic who is awaiting sentencing on charges she took kickbacks from Arizona-based Insys Therapeutics for dispensing Subsys to patients. The new data is the first indication that the propensity to prescribe Subsys extended beyond Alfonso, to other clinic staff. None of the other three nurses has been implicated in an ongoing federal probe of Insys’ marketing of Subsys that resulted in the criminal charges against Alfonso.

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Disclosure Rules Don’t Stem Flow Of Pharma Cash To State’s Doctors

Dozens of Connecticut doctors accepted six-figure payments from drug and medical device manufacturers in 2015 for consulting, speaking, meals and travel, with six of the 10 highest-paid physicians affiliated with academic institutions, new federal data show. The top 10 doctors – less than 0.1 percent of the 11,000 who received payments – took in $3.6 million, or nearly 15 percent of the total $24.9 million paid out. Among them is the dean of the Yale School of Medicine, Dr. Robert Alpern, who received $445,398 in 2015 from two companies – Abbott Laboratories and AbbVie – in consulting fees, meals and travel expenses for serving on the boards of both companies. In 2014, he received $458,194 from the two companies. The Yale medical school began a research partnership with AbbVie in 2013, after the pharmaceutical company spun off from Abbott Laboratories.

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Antipsychotic Use On The Decline In State Nursing Homes

Connecticut still ranks high among states in the use of antipsychotic drugs for elderly nursing home residents, but its rate of use has dropped 33 percent since 2011 – a bigger decline than the national average — new government data show. The data released in June by the Centers for Medicare & Medicaid Services (CMS), show that nursing home residents in Connecticut, many with dementia, are still more likely to be given antipsychotics than their counterparts in 31 other states. But the state’s usage has fallen in the last 4 ½ years at a greater rate than the average drop of 27 percent, and it is now about the same as the national average — 17.4 percent. That’s down from 26 percent in 2011. CMS has been working with states for the past five years to address the overuse of antipsychotic medications in nursing homes.

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State Prepares To Tighten Prescription Monitoring

Connecticut’s shift next month from weekly to “real-time” reporting of prescriptions for opioids and other controlled substances is an effective way to help stem opioid-related deaths, a new study suggests. Researchers from Vanderbilt University who analyzed states’ prescription drug monitoring programs – central databases that log controlled substances dispensed to patients — found that programs that were “updated with greater frequency” and that reported data for a broad range of drugs were associated with greater declines in opioid-related deaths. The study in the journal Health Affairs comes as Connecticut prepares to put a policy in place requiring that pharmacies report controlled substance (Schedule II to V) prescriptions “immediately,” or at least within 24 hours after they are dispensed, into the central database, known as the Connecticut Prescription Monitoring and Reporting System (CPMRS). The CPMRS, maintained by the Department of Consumer Protection, can be accessed by doctors and pharmacists to give them a complete picture of a patient’s medication use, including prescriptions by other providers. It also can be used by law enforcement officials to investigate physician prescribing.

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Derby Nurse Cooperating In Broadening Federal Probe

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.

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State’s Ambulatory Surgery Centers Get Mixed Ratings

Connecticut’s outpatient surgery centers fare well in preventing patient falls and wrong-site surgeries, compared to national rates, but poorly in avoiding patient burns and in ensuring that surgical patients get intravenous antibiotics, new federal data show. In addition, many of the state’s 45 Medicare-certified centers perform significantly more surgical procedures than the national average, with eight centers reporting more than double the average caseload. The data — recently made public by the Centers for Medicare & Medicaid Services (CMS) and now available on C-HIT’s website – show that Connecticut’s ambulatory surgery centers (ASCs) have a lower average rate of patients who suffer falls than the national average — .077, compared to .095. The data is from 2013 and 2014, the most recent years available. The state’s ASCs also have a lower rate, on average, of patients who experience a wrong-site, wrong-patient or wrong-procedure error — .017, compared to the national average of .028.

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State Hospital Inspection Reports Now Available On C-HIT

Lapses in cleanliness, infection-control procedures and in the treatment of patients with behavioral health problems were among the most common violations found in Connecticut hospitals inspected by the state health department in 2015, reports collected by C-HIT show. Inspection reports from the state Department of Public Health, spanning 2013 through 2015 – posted in C-HIT’s Data Mine section — show a mix of citations for poor physical conditions, such as mold and fungus in pharmacy preparation areas, and inadequate patient care, including improper evaluation and treatment of psychiatric patients and use of restraints. The state DPH inspects hospitals, which are all Medicare-certified through the federal government, once every four years. Inspections also occur when the DPH receives a complaint against a facility or is following up to ensure compliance with a corrective action plan. C-HIT’s database, based on DPH records through late 2015, includes reports on all 29 acute-care hospitals.

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