Derby Nurse’s Sentencing Delayed Until July

A federal judge has agreed to a six-month delay in sentencing a Derby nurse who pleaded guilty to accepting kickbacks in exchange for prescribing a powerful opioid painkiller because she is cooperating in “numerous ongoing criminal investigations,” according to court records. U.S. District Judge Michael Shea approved a Jan. 17 agreement between federal prosecutors and attorneys for Heather Alfonso that delays her sentencing another six months, until July 2017. Alfonso was charged in June 2015 with accepting $83,000 in kickbacks from Insys Therapeutics in exchange for her high prescribing of the drug Subsys. In arguing for the new sentencing delay, the U.S. attorney’s office in Connecticut said Alfonso “continues to cooperate in (investigations in) several federal and state jurisdictions, including the District of Connecticut.” A previous story by C-HIT reported on prior sentencing delays because she was cooperating in an ongoing federal probe.

FBI Reaches Out For Victims Of Subsys Scheme

In an unusual move, the FBI is reaching out publicly to patients who were prescribed the powerful narcotic medication Subsys, which federal agents allege was improperly dispensed by practitioners across the country, including a nurse in Derby. In a posting on its Victim Assistance Program website, the FBI asks people who were prescribed Subsys between March 2012 and December 2016 to complete a brief questionnaire that will assist in a federal probe of Insys Therapeutics, the company that makes Subsys. The appeal follows the indictments in December of six top executives and managers of Insys on charges they led a nationwide conspiracy to bribe doctors and nurses to prescribe Subsys, which is approved for treating cancer patients suffering episodes of breakthrough pain. In exchange for bribes and kickbacks, the practitioners wrote large numbers of prescriptions for patients, most of whom were not diagnosed with cancer, the indictments allege. One of the practitioners named in the indictments is Heather Alfonso, formerly an advanced practice registered nurse (APRN) at the Comprehensive Pain and Headache Treatment Center in Derby. She has pleaded guilty to accepting kickbacks from Insys through a sham “speakers’ program,” in exchange for prescribing Subsys.

Ten prescribers wrote more than 23 percent of the state's Medicare spending on opioids in CT.

Handful Of Prescribers Responsible For Large Share Of Opioids

Ten Connecticut prescribers, including a Derby nurse who is at the center of a federal kickback probe, were responsible for more than 23 percent of the state’s Medicare spending on opioids in 2014, suggesting that the largest share of those prescriptions is concentrated among a small number of clinicians. Recently released federal Medicare data show that Heather Alfonso, formerly a nurse with the Comprehensive Pain & Headache Treatment Centers, LLC, in Derby, and four other advanced practice registered nurses (APRNs) at the clinic in 2014 dispensed more than $8.4 million in opioids in the Medicare program – accounting for a full 15 percent of all such prescriptions in the state. They were among the top 10 opioid prescribers in 2014, who accounted for $13 million of the $56 million spent on the drugs, the data show. More than 4,800 Connecticut clinicians, mostly physicians, wrote Medicare prescriptions for oxycodone, fentanyl and other opioids. But the prescribing was not evenly spread out – only two-dozen prescribers wrote out more than $250,000 worth of prescriptions.

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.

C-HIT-Subsys-Graphic-2016-08

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.

Derby Nurse Pressured By Drug Company To Boost Sales

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.

Drug Company Tied To Connecticut Nurse Settles Kickback Case In Oregon

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.

Derby Pain Clinic Terminated From Medicaid Program

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.