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.
US Sen. Richard Blumenthal (D-Conn.) and U.S. Sen. Chuck Grassley (R-Iowa) have introduced legislation that would require drug companies and medical device manufacturers to start reporting their payments to nurse practitioners and physician assistants, as they do for physicians. “Requiring companies to disclose gifts and payments made to other health care providers – not just doctors – is absolutely essential,” Blumenthal said in a statement Tuesday. “The Provider Patient Sunshine Act will rein in dishonorable behavior by increasing transparency and accountability across the entire healthcare industry.”
Grassley added: “It makes sense to apply the sunshine (provisions) to anyone who prescribes medicine.”
The proposed Provider Payment Sunshine Act, would require drug companies and device makers to publicly disclose payments to nurse practitioners and physician assistants for promotional talks, consulting and other services. The companies already report such payments to physicians in a national Open Payments database, under prior legislation co-authored by Grassley. The payments to nurse practitioners and physician assistants would be added to that database. Nurse practitioners and physician assistants write a significant number of prescriptions in the federal Medicare program, data show.
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.
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.