Fines & Sanctions

Derby Nurse Pressured By Drug Company To Boost Sales

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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.

Fines & Sanctions

Blumenthal, Grassley Call For Expanded Drug Company Reporting

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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.

Affordable Care Act

State Residents Not Using Free Preventive Care, Worried About Costs, Survey Finds

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Kathy Navaroli, 50, of Windsor, hadn’t seen a primary care doctor in years when she decided to go for a physical this summer. She didn’t ask about preventive care screenings, such as a mammogram or Pap test, in part because she worried they might involve an insurance co-pay or deductible. Her household income is below $30,000 a year. “I got a physical, they did some blood work, and that was it,” she said. Kerrishian McCants, 31, of Hartford, a mother of four, has a family history of diabetes and high blood pressure, but has not discussed those possible risks with her doctor.

Fines & Sanctions

Reporting Of Pharma Payments To APRNs To Start In 2017

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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.

Fines & Sanctions

State’s Dialysis Centers Rate High, With Some Exceptions, New Data Show

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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.

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.

More Than 90 Percent Of CT Hospitals Face Readmissions Penalties

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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.

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.

Fines & Sanctions

Highest Prescribers Of Cancer Drug Paid As Speakers

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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.

Fines & Sanctions

Meriden Family Sues Nurse For “Potentially Deadly” Prescribing

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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.