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.
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.
A Derby nurse who admitted taking kickbacks from a drug company that makes the powerful painkiller Subsys was pressured by sales representatives to increase her prescribing “so that the Subsys numbers would also increase,” according to court documents. In a hearing transcript recently made public, federal prosecutors charged that Heather Alfonso “continued to increase her prescribing of Subsys and to find more patients for whom she could prescribe the drugs” in exchange for a series of $1,000 kickbacks, totaling $83,000, from the company, Insys Therapeutics. Although the potent narcotic is approved only for cancer patients, some of the patients given Subsys by Alfonso “did not have a cancer diagnosis,” which would have meant that Medicare and private insurers would have refused to pay claims, federal prosecutors said. But “prior authorizations” submitted on behalf of patients falsely represented that they had cancer, misleading insurers into paying for the drug. It is not clear in the testimony who was involved in submitting the false authorizations to Medicare and insurers.
A state initiative that would have required drug companies and device manufacturers to start reporting their payments to advance practice registered nurses (APRNs) this year has been delayed to 2017. The original APRN legislation, passed in 2014, called for quarterly reporting beginning in July 2015. That law was amended this spring to push back the start date and require only annual reporting, after urging from the pharmaceutical industry, state officials said. The delay comes as an APRN at a pain clinic in Derby, Heather Alfonso, awaits sentencing on charges that she received kickbacks from the drug company Insys Therapeutics in exchange for prescribing a potent painkiller intended for cancer patients. The payments to Alfonso for promoting the drug were not reported publicly under federal rules because APRNs are not included in the Physician Payment Sunshine Act, which requires public reporting of drug company payments only to physicians and teaching hospitals.
The company alleged to have paid kickbacks to a Derby nurse in exchange for her prescribing of a potent pain medication has agreed to pay $1.1 million to settle a case brought by the state of Oregon, which accused the firm of deceptive marketing and kickback payments involving the same drug. In a notice of unlawful trade practices filed against the Arizona-based drug maker Insys, the Oregon attorney general’s office charged that the company used an “unconscionable tactic by making payments to doctors that you intended to be a kickback to incentivize the doctor to prescribe Subsys.” The attorney general also charged Insys with using “unconscionable, false and deceptive sales tactics” designed to increase the “off-label” use of Subsys, which is approved only to treat breakthrough cancer pain. The case in Oregon comes as Connecticut nurse practitioner Heather Alfonso, formerly with the Comprehensive Pain and Headache Treatment Center in Derby, awaits sentencing on charges she received $83,000 in kickbacks from Insys from 2013 to 2015. In pleading guilty, Alfonso, 42, admitted that the money she was paid for attending “dinner programs” as a speaker — many of them sham dinners, with just an Insys sales representative or her friends or co-workers — influenced her prescribing of the drug, according to the U.S. Attorney’s Office for Connecticut. 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.
The state has barred practitioners at a Derby pain clinic, including a high-prescribing nurse, from participating in the Medicaid program because of improprieties in treatment and oversight. Documents from the Department of Social Services (DSS) show the physician heading the clinic, Dr. Mark Thimineur, and four nurses and assistants were notified in July that their participation in the Connecticut Medical Assistance Program, which includes Medicaid, is being terminated on Aug. 30. Those terminations came after Heather Alfonso, an advanced practice registered nurse (APRN) at the privately run Comprehensive Pain & Headache Treatment Centers, was removed from the Medicaid program in May, DSS officials said. Alfonso was identified in a February story by C-HIT as among the top 10 prescribers nationally of the most potent controlled substances in Medicare’s drug program in 2012 — Schedule II drugs, which have a high potential for addiction and abuse.
Eight of the top 10 prescribers of a potent narcotic used for cancer pain were paid more than $870,000 in speaking fees by the drug maker in 2013 and 2014 — indicating that Derby nurse Heather Alfonso was not the only high prescriber compensated by the company. Alfonso, an advanced practice registered nurse (APRN) who worked at the Comprehensive Pain and Headache Treatment Center in Derby, pleaded guilty last month to accepting $83,000 in kickbacks from 2013 to March 2015 from the drug company Insys Therapeutics, which has heavily marketed a painkiller called Subsys, a sublingual fentanyl spray approved only for cancer patients. Alfonso was paid to speak about Subsys at more than 70 “dinner programs,” but most of those programs were attended only by her and a sales representative for Insys, or by Alfonso’s colleagues and friends who had no authority to prescribe the drug, according to the U.S. Attorney’s Office for Connecticut. Alfonso faces a maximum prison term of five years and a fine of up to $250,000 on the charge of receiving kickbacks in connection with a federal healthcare program. In pleading guilty, she admitted that the money she was paid influenced her prescribing of Subsys, often to non-cancer patients, federal investigators said.
The family of a Meriden man who died in 2013 at age 56 is suing Derby nurse practitioner Heather Alfonso and the pain clinic where she worked, alleging that her rampant overprescribing of narcotics contributed to his death. Joseph Torchia’s wife and son claim in a lawsuit filed in Waterbury Superior Court that Alfonso, who was recently charged by federal prosecutors with accepting kickbacks from a drug company, prescribed “unlawfully high” doses of narcotics to Torchia for more than a year, ignoring signs that he was suffering from liver cirrhosis, gallbladder disease, internal bleeding and narcotics’ dependency. The suit alleges that Alfonso’s reckless prescribing weakened Torchia’s medical condition, so that his ability to recover from gallbladder surgery on Jan. 14, 2013, was compromised. He died three weeks after that surgery.
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.
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.