Fines & Sanctions

Drug Company Tied To Connecticut Nurse Settles Kickback Case In Oregon

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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.

I-Team In-Depth

Derby Pain Clinic Terminated From Medicaid Program

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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.

I-Team In-Depth

High-Prescribing Nurse Surrenders Drug Licenses

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A Derby nurse practitioner whose prolific prescribing of potent narcotics was the subject of a February story by C-HIT has surrendered her state and federal licenses to prescribe controlled substances and is the subject of an “open investigation” by the state health department, officials said Monday. Heather Alfonso, an advanced practice registered nurse (APRN) at the Comprehensive Pain & Headache Treatment Centers, LLC, in Derby, surrendered her controlled substance registration after a recent probe by the Drug Control Division of the Department of Consumer Protection, a spokeswoman for the department confirmed. “The controlled substance registration of this provider has been turned in,” said the spokeswoman, Claudette Carveth. She said the agency had no further comment. Meanwhile, William Gerrish, a spokesman for the Department of Public Health, said his agency has an ongoing investigation into Alfonso’s APRN license, which is separate from her prescribing registration.

Disparities

More Dentists Now Treating Low-Income Patients, But Coverage Gaps Persist

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Thousands of low-income adults and children have gained access to dental services in recent years as the number of dentists accepting Medicaid and HUSKY patients has soared, according to state data. At the end of last year, there were 2,002 dentists who accepted Medicaid or HUSKY plans. That’s nearly three times the 703 dentists who accepted Medicaid or HUSKY on Dec. 31, 2008, according to the state Department of Social Services (DSS). “That’s a pretty expansive network,” Donna Balaski, director of dental services at DSS, said of the 2014 figure.

Disparities

Legislature Asked To Raise Asset Level for Medicaid Spouses

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Allowing the spouse of a person in a nursing home to keep enough money to live on independently is, in many ways, a moral issue. But in a tight budget year in Connecticut, it’s a fiscal issue. A proposal that would increase the minimum assets that a spouse living in the community can keep — from $23,844 to $50,000 – in order for his or her partner to be eligible for Medicaid nursing home care is being backed by elder advocates, who say the increase would help seniors, especially women, remain able to live independently. But the move is being opposed by the Department of Social Services on the grounds it will shift millions in costs to the state-funded Medicaid program. The proposal would affect couples with combined assets of between $23,844 and $100,000.

I-Team In-Depth

Operating Profits Drop At State Hospitals: New Report

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Connecticut’s acute-care hospitals saw gains from their operations tumble 35 percent in the last fiscal year, with seven of 29 hospitals reporting operating losses, according to a new state report. While hospitals still ended the year with $597 million in profits overall, the report by the state Office of Health Care Access (OHCA) raises concerns that non-operating revenue, such as income from investments, was masking the decline in operating revenue. “While hospitals’ operational financial performance weakened in FY 2013, they continued to generate significant non-operating gains, helping to keep overall hospital financial performance strong,” the report says. “However, a robust financial picture should rely more on patient and other operating revenues, and not on a less than reliable income source, such as investment performance.”

Hospitals’ profits from operations dropped to $333.6 million, from $513.5 million in the 2012 fiscal year. At the same time, hospitals earned $70 million more from investments, charitable contributions and other sources of revenue.

Disparities

Medicaid To Cover Autism Therapies For Children, Teens

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Plans are underway to provide thousands of individuals under age 21 with autism spectrum disorder (ASD) with home-based interventions and other services through the state’s Medicaid program beginning Jan. 1. “This is absolutely huge,” said Jennifer Bogin, director of Autism Spectrum Services for the Connecticut Department of Developmental Services (DDS). “Many children already get quality programming during the school day. But it’s rare when that programming is brought into the home.

Access Health CT

Diligence Pays Off When Shopping For Health Insurance

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Connecticut consumers who carefully consider their health status and financial needs stand to reap the greatest benefits when shopping for insurance during the 2015 open enrollment period. The enrollment period to purchase coverage at Access Health CT (AHCT), the online marketplace created by the Affordable Care Act, runs from Nov. 15, 2014, to Feb. 15, 2015. The law requires most Americans to carry health insurance or pay a fine when they file their federal income taxes.

I-Team In-Depth

Should You Take The Health Care Tax Hit?

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Time is running out for thousands of uninsured Connecticut residents who must decide whether to comply with a federal mandate to buy health insurance starting Jan. 1, 2014 or pay a penalty instead. “We are undertaking a paradigm shift in how we think about health insurance,” said Dan M. Smolnik, a tax attorney from Brookfield. “We don’t know for sure how people in Connecticut will respond. But I think the majority will weigh the risks of not having health insurance and make a rational decision that isn’t purely based on economics.

I-Team In-Depth

Thousands Of Nursing Home Beds Empty As State Rebalances Care

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At the Governor’s House Rehabilitation & Nursing Center in Simsbury, 17 of the nursing home’s 73 beds sat empty this spring – a 23-percent vacancy rate that would have been unlikely five years ago. The home’s occupancy has fallen despite its above-average health care quality scores in the federal government’s rating system. “There are a lot of factors – a lot of initiatives out there now to keep people out of nursing homes,” said Keith Brown, the home’s administrator. “And with the increase in home care, we’re seeing a more frail resident population. So we have fewer residents, with higher acuity.”

The Simsbury home is not unique: Nearly a third of Connecticut’s nursing homes are less than 90 percent occupied, with Litchfield and Tolland counties bearing the highest vacancy rates, an analysis of state data shows.