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.

Alfonso was employed by the Comprehensive Pain and Headache Treatment Center, located in Derby.

A federal prosecutor said that Alfonso was being paid to prescribe Subsys “off-label, for people who she thinks she’s entitled to prescribe it to, although Medicare won’t pay for it . . . “I’m not proffering that Ms. Alfonso is the one who submitted the claims for authorization or that she’s the one that made the misrepresentations. Maybe the evidence is developed that supports that and maybe it isn’t.”

Alfonso’s lawyer, Ryan McGuigan of Hartford, said his client had no comment. Calls to Insys and the pain center were not returned. Insys has previously denied any wrongdoing in its marketing of Subsys. Dr. Mark Thimineur, head of the pain center, has not been implicated in the federal kickback case.

At the June hearing in U.S. District Court in Hartford, Alfonso, 42, of Middlebury, an advance practice registered nurse (APRN), pleaded guilty to accepting kickbacks in relation to a federal healthcare program. She is awaiting sentencing. Sentencing guidelines in her case call for 46 to 57 months’ imprisonment, a fine of up to $100,000 and a requirement that she make restitution.

Alfonso was among the highest prescribers of Subsys in the country, writing out prescriptions at what prosecutors called “an alarming rate.” Medicare and private insurers paid out about $1.6 million from 2013 to 2015 for the prescriptions she wrote while she was receiving kickbacks from Insys, court records say.

Alfonso admitted in court that Insys paid her through a sham “speakers program,” supposedly to give presentations to other prescribers about Subsys. Instead, court documents say, Insys paid her about $1,000 per event for going out to dinner with friends and co-workers, or with just an Insys sales rep.

Alfonso said in court that she was “not the one responsible to get attendees” for the dinners. But when U.S. District Judge Michael P. Shea asked her, “You understood at the time that you were receiving these payments, in whole or in part, in return for your prescribing Subsys, is that true?” she answered, “Yes, Your Honor.”

Prosecutors said they had agreed to reduce Alfonso’s offense level based on her “prompt recognition and affirmative acceptance of personal responsibility” for the offense.

No one from Insys has been charged in Alfonso’s case, but federal prosecutors appear to be intensifying a wider investigation into the company’s marketing practices.

Nationally, Insys paid out about $10 million to more than 3,000 physicians in 2013 and 2014, most of it for speaking engagements, federal records show. A C-HIT story in July found that eight of the top 10 prescribers of Subsys were paid more than $870,000 in speaking fees by the drug maker in 2013 and 2014 — indicating that Alfonso was not the only high prescriber compensated by the company.

Alfonso was identified in earlier C-HIT stories as the state’s highest Medicare program prescriber of Schedule II drugs – potent narcotics with a high potential for addiction and abuse. She was among the top 10 Schedule II prescribers in the country in 2012 and was the highest prescriber in Connecticut in 2013, writing $2.7 million in prescriptions.