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.
Connecticut has a high prevalence of Medicare beneficiaries living with Alzheimer’s disease or other dementias, often placing an enormous financial strain on caregivers who are spending thousands of dollars a year on care, reports show. “Alzheimer’s is the most expensive disease in America,” said Jennifer Walker, vice president of communications and advocacy for the Connecticut chapter of the Alzheimer’s Association. “The cost of care is very high.”
Medicare covers most fees for doctor visits, and some hospitalization, if needed; but other costs associated with care—including home health services, transportation, diapers for incontinence—are not covered. People with Alzheimer’s often suffer from other chronic illnesses such as diabetes, heart and hypertension, which add to the out-of-pocket costs for care. The financial burden is forcing families who rely on Medicare to tap into retirement savings, cutback on food and medical care for themselves, reduce work hours or quit work altogether to be caregivers, according to the Alzheimer’s Association report Alzheimer’s Disease Facts and Figures.
Six dialysis facilities in Connecticut received low quality-of-care scores under newly updated federal Medicare ratings, while 11 facilities received the highest rating possible. Connecticut has 45 dialysis facilities in the Medicare program, all but four of them for-profit. Of the 41 for-profit centers, the majority are owned by two chains – DaVita, which has 24, and Fresenius Medical Care, with 13. The federal Medicare program rates dialysis facilities on a scale of one to five stars, based on nine measures of quality of care. The measures include mortality and hospitalization rates of patients, as well as rates of hypercalcemia, catheterization of more than 90 days, and the percentage of dialysis patients who had enough wastes removed from their blood during dialysis.
A Stamford-based podiatrist faces hefty fines and prison time after she pleaded guilty this week to submitting fraudulent Medicare claims.
Amira Mantoura pleaded guilty Monday in Hartford federal court to one count of making a false statement to Medicare after she billed the government program for foot surgeries when she merely clipped patients’ toenails, according to Deirdre M. Daly, U.S. Attorney for the District of Connecticut. Mantoura, 53, lives in Greenwich and has a practice at 95 Morgan St., Stamford. In her guilty plea, she admitted that she submitted false claims to not only Medicare, but Medicaid and private insurance companies as well, Daly said. Reached by phone at her practice Tuesday, Mantoura declined to comment. According to court documents, between January 2009 and August 2013, Mantoura “knowingly submitted materially false claims” seeking payment for nail avulsions, which are surgical treatments for ingrown toenails.
Five dialysis facilities in Connecticut received low quality-of-care scores under a new Medicare rating system, including one center cited for a high death rate, while 11 facilities received the highest rating possible, federal data show. Connecticut has 45 dialysis facilities in the Medicare program, all but four of them for-profit. Of the 41 for-profit centers, the majority are owned by two chains – DaVita, which has 24, and Fresenius Medical Care, with 13. Medicare began rating dialysis facilities earlier this year on a scale of one to five stars, based on nine measures of quality of care. The measures include mortality and hospitalization rates of patients, as well as rates of hypercalcemia, catherization of more than 90 days, and the percentage of dialysis patients who had enough wastes removed from their blood during dialysis.
All but one of Connecticut’s acute-care hospitals will lose Medicare reimbursement in 2015-16 as a penalty for high readmissions of discharged patients, new federal data show. The penalties against 28 hospitals mean Connecticut has one of the highest percentages nationally – more than 90 percent — of hospitals facing Medicare reductions. Only the Hebrew Home and Hospital of West Hartford escaped penalties; the Connecticut Children’s Medical Center is exempted from the federal program. None of the state’s hospitals faces the maximum 3 percent reduction to Medicare reimbursement, but seven face reductions of more than 1 percent. They are: Milford Hospital (1.70 percent); Middlesex, in Middletown (1.38); Johnson Memorial, in Stafford Springs (1.27); Charlotte Hungerford, in Torrington (1.19); St.
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.
The medical director of a pain clinic in Derby was reprimanded and fined $7,500 on Tuesday by the state Medical Examining Board for writing prescriptions for patients based on assessments of their appearance or behavior conducted by unlicensed medical assistants. Dr. Mark Thimineur, medical director of the privately run Comprehensive Pain & Headache Treatment Centers, LLC, housed at Griffin Hospital, signed a consent order on June 1 agreeing to the punishment. In the order, he did not contest the findings by the board and the state Department of Public Health. The consent order states that from 2011 to the present, Thimineur failed to meet the standard of care when treating one or more patients for chronic pain. It said he wrote prescriptions for patients based on assessments by unlicensed medical assistants of the patients’ physical appearance, behavior, pain levels or lab test results.
Ten Connecticut prescribers, including a Derby nurse practitioner who is under investigation by the state, were responsible for more than 22 percent of the state’s Medicare spending on potent narcotics in 2013, new federal data show. More than 4,300 Connecticut clinicians, mostly physicians, wrote Medicare prescriptions for oxycodone, morphine and other Schedule II drugs, which have a high potential for abuse and addiction, at a total cost of $40 million. But a handful of those providers accounted for the largest share of those prescriptions, an analysis of the data show. Topping the list, in both the number of prescriptions and cost, was Heather Alfonso, an advanced practice registered nurse (APRN) at the Comprehensive Pain & Headache Treatment Centers, LLC, in Derby, who wrote out 8,523 prescriptions, at a cost of $2.7 million. Statewide, the average number of prescriptions per clinician was 104, and no other prescriber had more than 5,000 Schedule II claims. The average cost per prescriber was $9,138; the next closest individual cost was $1.8 million.