Connecticut – An Advanced Practice Registered Nurse (APRN), Heather Alfonso,of South Carolina, was sentenced on Tuesday, November 26, for her role in a kickback scheme related to fentanyl spray prescriptions.
Alfonso formerly resided in Connecticut and was employed by Comprehensive Pain and Headache Treatment Center (CPHTC) located in Derby, Connecticut, according to court documents and statements made in court.
As part of her practice, according to the Department of Justice, Alfonso prescribed various controlled substances, including Subsys, a fentanyl-based sublingual spray that was approved by the Food and Drug Administration solely for the management of breakthrough pain in cancer patients. Subsys was manufactured and sold by Insys Therapeutics, an Arizona-based pharmaceutical company.
Alfonso was responsible for approximately $2.5 million in claims and was the highest prescriber of the drug in Connecticut, according to a review of Medicare Part D prescription drug events for prescribers of Subsys.
Interviews with several of Alfonso’s patients, who were Medicare Part D beneficiaries and were prescribed Subsys, revealed that most of them did not have cancer, but had taken the drug to treat their chronic pain. Medicare and most private insurers did not pay for Subsys unless the patient had an active cancer diagnosis and an explanation that the drug was needed to manage the patient’s cancer pain.
An investigation revealed that Insys Therapeutics representatives were inducing medical practitioners around the country to prescribe Subsys over other similar medications by paying the medical practitioners to participate in hundreds of sham “Speaker Programs.” The Speaker Programs, which were typically held at high-end restaurants, were ostensibly designed to gather licensed healthcare professionals who had the capacity to prescribe Subsys and educate them about the drug. In truth, the events were usually just a gathering of friends and co-workers, most of whom did not have the ability to prescribe Subsys, and no educational component took place. “Speakers” were paid a fee that ranged from $1,000 to several thousand dollars for attending these dinners. At times, the sign-in sheets for the Speaker Programs were forged to make it appear that the programs had an appropriate audience of healthcare professionals.
Between approximately January 2013 and March 2015, Insys Therapeutics paid Alfonso approximately $83,000 to act as a “speaker” for more than 70 dinner programs. In many instances, the dinner programs were only attended by Alfonso and an Insys Therapeutics sales representative. In other instances, the programs were attended by CPHTC staff and Alfonso’s friends, none of whom had licenses to prescribe controlled substances.
Alfonso’s conduct resulted in a loss to Medicare of $2,564.501.64. Judge Arterton ordered Alfonso to pay full restitution, jointly and severally with other defendants convicted in this scheme.
On June 25, 2015, Alfonso pleaded guilty to one count of receiving kickbacks in relation to a federal healthcare program.
Several other individuals affiliated with Insys Therapeutics, and medical practitioners involved in this kickback scheme, have been charged and convicted in the District of Connecticut and in other Districts across the U.S. On May 2, 2019, a federal jury in Boston found John N. Kapoor, the founder and former Executive Chairman of Insys Therapeutics, and four other former Insys executives guilty of racketeering conspiracy.
In sentencing Alfonso, Judge Arterton credited Alfonso’s prompt acceptance of responsibility, her assistance to the government’s prosecution of other defendants, and the extensive testimony she provided during the trial in the District of Massachusetts.
In June 2019, Insys Therapeutics agreed to pay a total of $225 million to resolve criminal and civil investigations of the company.