Saturday, December 17, 2016

Medical mayhem 5

To encourage a Florida doctor to write more prescriptions of the potent painkiller Subsys, executives of the drug’s maker invited him to company headquarters near Phoenix and took him out for a night on the town, according to a federal indictment released Thursday.

Two top sales officials of Insys Therapeutics entertained the physician at a “club,” where they stayed until 4 a.m. “Went fantastic last night,” one of the company’s regional sales managers wrote in a text message to a sales rep, the indictment says. “He had to have had one of the best nights of his life.”

The next week, the doctor wrote 17 prescriptions for Subsys — a legal form of the opioid fentanyl — when he usually averaged about three. He also received $260,050 in payments over three years for participating in the Insys speaking program — something federal officials allege was nothing more than a mechanism for bribing doctors.

Federal prosecutors in Boston allege the Florida doctor was one of several medical practitioners bribed by Insys employees as part of a national conspiracy to boost sales of Subsys. Six former Insys executives and sales managers were arrested Thursday in response to a 60-page indictment detailing allegations of bribery and kickbacks.

Insys said in a statement that it is cooperating with authorities and “committed to complying with laws and regulations.”

Subsys was launched in March 2012 into a crowded field of competitors, which included other brand-name medications and several generics. The drug was approved only for cancer patients with intense flares of pain — a narrow market — and only about 2,000 doctors in the country prescribed fentanyl products. The drug is also expensive, costing thousands of dollars a month.

The company, prosecutors allege, overcame these challenges with a speaker program — whose stated purpose was to educate doctors on the use of the drug — to bribe doctors. In an email titled “Live Speaker Targets,” former Insys chief executive Michael Babich wrote to sales managers to make certain sales reps understood “the important nature of having one of their top targets as a speaker. It can pay big dividends for them.” In a text message to a sales rep, former Insys vice president of sales Alec Burlakoff wrote that doctors “do not need to be good speakers, they need to write a lot of” Subsys prescriptions.

To sweeten the pot, the Insys employees allegedly scheduled speaking events at establishments owned by doctors, or their families and friends. The events allegedly had little do with education: They were often held at high-priced restaurants and attendees were frequently just friends of the doctor hired as the speaker, the indictment alleges. Fake names were used on sign-in sheets, and some events had no attendees at all, according to prosecutors.

The indictment does not identify by name any of the practitioners who allegedly received the bribes and kickbacks.

The company meticulously tracked results from the speaker program, calculating a ratio of return on investment for each speaker using metrics such as the number of prescriptions written by the speaker and the total amount the company paid the doctor. If doctors failed to boost their prescribing after being paid to be an Insys speaker, the company would reduce the number of their speaking engagements, according to the indictment.

In the case of an advanced practice nurse in Connecticut, the sales manager for that state became frustrated when the nurse failed to prescribe more Subsys after being paid as a speaker. “Very simply when I look at return on investment as she has not motivated any new prescriber as of yet and she is not significantly increasing her own business, I am going to have tremendous difficulty in justifying more programs,” the manager wrote. The nurse eventually increased her prescribing and received $78,748 in speaking fees from the company.

One doctor in Arkansas allegedly promised Insys sales reps “more scripts than we can handle” once he started to be paid as part of the company speakers program.

In 2012, Burlakoff traveled to Michigan to meet with a doctor who owned a Saginaw pain clinic with more than 5,000 patients. Insys wanted him to write more Subsys prescriptions. After taking the doctor to dinner, the indictment alleges Burlakoff sent an email to members of the sales team telling them “expect a nice ‘bump’ fellas.”

The Michigan doctor was enrolled in the speakers program, receiving payments totaling $138,435, and his prescribing of Subsys increased, according to the indictment. Doctors like the one in Michigan “keep us in business,” Burlakoff wrote. He added, “let’s get a few more and the rest … of this job is a ‘joke.’”

An attorney for Burlakoff, George Vien of Boston, said his client would plead not guilty and “fight the case.” The other defendants or their lawyers couldn’t be immediately reached for comment.

The Insys sales force targeted the top prescribers of all fentanyl products, according to the indictment.

When Babich received a list of doctors in the Insys speaker program writing a large number of prescriptions for competitors’ drugs, he allegedly emailed Burlakoff. “I thought we owned the high decile folks?” he wrote. “Lots of big names on there.”
Courtesy of Doximity


  1. Some 21 doctors, executives, investors and others have been accused of a massive conspiracy to direct patients to the Forest Park Medical Center in Dallas in exchange for money.

    The group dished out nearly $40 million in bribes and kickbacks which influenced doctors to refer higher-paying patients to the medical center, according to the U.S. Department of Justice.
    The group was charged in a sealed indictment last month following an FBI investigation. The indictments were unsealed Thursday.

    FPMC was an out-of-network hospital in Dallas, prosecutors said. This meant it could usually set its own prices and receive greater reimbursements from some patients.

    It also meant patients whom doctors and surgeons referred to FPMC usually had high-reimbursing out-of-network private insurance benefits, according to the indictment.

    According to the indictment, two surgeons were paid over $3 million to refer their patients to FPMC. Another surgeon allegedly received $7 million in exchange for a referral. Many of the doctors and surgeons involved were also FPMC investors.

    “The surgeons spent the vast majority of the bribe payments marketing their personal medical practices, which benefitted them financially, or on personal expenses, such as cars, diamonds, and payments to family members,” the Justice Department said.

    From 2009 to 2013, the medical center allegedly collected over $500 million from patient insurance plans and over $200 million in paid claims.

    “Medical providers who enrich themselves through bribes and kickbacks are not only perverting our critical health care system, but they are committing a serious crime,” U.S. Attorney John Parker said in a statement.

    The long list of doctors, surgeons, investors and executives who are under investigation could receive up to 20 years in federal prison and a $250,000 fine.

    It could also force the defendants to forfeit “any property, real or personal, which constitutes or is derived from proceeds traceable to the offenses," prosecutors said.

    Here is a list of 21 people indicted:

    Source: Grand Jury Indicts 21 Doctors, Executives in Massive Conspiracy Involving Dallas Hospital | NBC 5 Dallas-Fort Worth

    Courtesy of a colleague

  2. The trend of holding physicians personally responsible for healthcare crimes has continued unabated over the past year. As noted in a previous article, physicians are particularly attractive targets for federal prosecutors due to the "special skill" and "abuse of trust" sentencing enhancements found in the U.S. Sentencing Commission Guidelines. While measuring physician participation in illegal activity is difficult, a review of U.S. Department of Justice (DOJ) press releases and select state prosecutions over a 12-month period shows that healthcare fraud appears to be the most popular charge. Common healthcare fraud violations committed by physicians involved lab schemes, medically-unnecessary services, false statements, fraudulent billing, patient-related offenses, kickbacks and bribes, and prescription drug schemes…

    Based on our review of the cases in which age information was readily available, the majority of defendants were between 50 and 70 years of age, raising the question as to whether physicians in their mid-to-late years of practice commit more fraud, and if so, why. Such findings, while arguably anecdotal in nature, point to areas where healthcare and physician organizations are at risk and yield important information for developing and fine-tuning a compliance-auditing regime. In addition, with the exception of sexual assault and similar crimes, the physicians involved tended to be associated with smaller, non-institutional practices. This could be an indicator of the need for improved and continuous compliance training for physicians in smaller practices as they approach the midpoint of their careers and beyond…

    False Statements…
    Prescription Drug Schemes…
    Medically Unnecessary Services…
    Fraudulent Billing…

  3. Jury Awards $1M to MD Fired After Reporting "Sexual Predator"

    In October, a jury in Cook County, Illinois, awarded $1 million to an emergency medicine physician who claimed his hospital fired him in 2011 for reporting that another physician was sexually harassing female residents, or so he believed. For Brett Ohlfs, MD, the trial was not about proving the allegation about his former colleague at Advocate Christ Medical Center in suburban Chicago, part of Advocate Health Care. The issue was whether Advocate retaliated against him for raising the issue. The jury said it did. Shortly after his dismissal, Dr Ohlfs and his wife and children moved to Redding, California, and he got a job at Shasta Regional Medical Center. Five years later, he describes what happened at Advocate as if it were a fresh wound. "I'm still kind of the black sheep," he said. "Money would never make me whole for what we've been through." What Dr Ohlfs alleged is nothing new. Three in 10 women in a survey of high-achieving medical academics said they experienced sexual harassment on the job, according to a recent study in JAMA.

  4. Physician Pleads Guilty to Torching Rival's Office

    Anthony Moschetto, DO, a cardiologist on Long Island, New York, had a business problem with a colleague-turned-rival, which landed him in court. In October, Dr Moschetto pleaded guilty to setting fire to the other physician's office in Great Neck, New York, and conspiring to have him beaten up. But it was more complicated than that. Prosecutors said that a police investigation of illegal oxycodone prescriptions written by Dr Moschetto unexpectedly uncovered a murder-for-hire plot targeting an unnamed fellow cardiologist with whom Dr Moschetto had practiced for 20 years. He vacillated between killing and merely assaulting the other physician before settling on the latter by the time of his arrest on April 14, 2015. Dr Moschetto had enough tools at his disposal for all sorts of havoc. When police searched his mansion in Sands Points, New York, they found roughly 100 weapons, including rifles with illegal, high-capacity magazines; knives; and a grenade. Many of them were stored in a secret room behind a switch-activated moving bookshelf. Dr Moschetto was scheduled to be sentenced December 16, but the hearing was postponed. As of press time, a new date had not yet been set.

  5. Physician Charged in Pill Mill Scheme Found Dead

    Alfred Ramirez, MD, a New York psychiatrist accused of illegally prescribing 10,000 tablets of oxycodone, sometimes from the front seat of his gold Lexus, was found dead in his home October 16. Dr Ramirez had pleaded not guilty to federal charges of illegally distributing oxycodone and other controlled substances that prosecutors said had resulted in at least one overdose death. Police did not find signs of foul play when they discovered Dr Ramirez's body at his home in Monroe, New York. The federal charges against Dr Ramirez stemmed from a 5-month investigation in 2015 spearheaded by the DEA. In a complaint filed September 30, 2015, in the federal district court in New York City, DEA Special Agent Michael Muller said that Dr Ramirez had conspired with co-defendant James Cooney to illegally distribute oxycodone, alprazolam (Xanax), and other drugs. In some instances, Dr Ramirez allegedly wrote scripts for individuals without conducting a physical exam. He would see customers as late as 10 pm, charging anywhere from $150 to $400 in cash for his signature on prescriptions.

  6. Victims Seek Payments as 'Dr. Death' Declares Innocence

    As of November 22, more than 500 former patients and their families had filed claims against Farid Fata, MD, the Detroit-area oncologist convicted of raking in over $17 million by poisoning patients with chemotherapy and other drugs they did not need. Dr Fata, dubbed "Dr Death" by his victims, was branded by prosecutors as "the most egregious fraudster" in US history for scamming Medicare and private insurers by giving at least 553 patients, some of whom did not have cancer, thousands of doses of unnecessary and expensive drugs. But Dr Fata insists he did nothing wrong, saying victims claiming he killed loved ones or ruined their lives are misguided and that those who died were "going to die anyhow because of the nature of the diseases." Dr Fata is serving a 45-year sentence in a federal prison in South Carolina after pleading guilty to 13 counts of healthcare fraud, 1 count of conspiracy to pay or receive kickbacks, and 2 counts of money laundering.

  7. Pill Mill Doctor to Serve Jail Time

    In August, Tressie M. Duffy, MD, a West Virginia physician, was sentenced to a year and a day in jail after pleading guilty to seven felonies for illegal distribution of oxycodone. The sentence, along with an $18,200 penalty, was handed down in late June. Dr Duffy practiced at West Virginia Weight and Wellness Inc, a family medicine clinic in Martinsburg, West Virginia. She was facing up to 20 years for each count, plus a fine of up to $1 million for each count. Dr Duffy, 46, has a history of scrapes with the law going back to at least 2009. She also had been censured three times by the West Virginia Board of Medicine. That was before she pled guilty in December 2015 — the result of a US Attorney's Office investigation. A 100-count indictment issued in 2014 charged Dr Duffy and two coworkers with illegally issuing 157 prescriptions for oxycodone, oxymorphone, methadone, and methylphenidate between 2010 and 2012. According to the 2014 indictment, Dr Duffy left signed, blank prescription forms for coworkers to issue narcotics — without her ever seeing a patient.

  8. Florida Oncologist Faces 500 Years in Prison

    Florida oncologist Diana Anda Norbergs, MD, 61, faces more than 500 years in prison for unethical prescribing practices and fraud. In November, the former owner and operator of East Lake Oncology, a cancer treatment clinic located in Palm Harbor, Florida, was convicted of smuggling unapproved and misbranded drugs into the United States and giving them to her patients. She would then also bill Medicare and other insurers for the more expensive US versions. A 2-week trial that ended on November 16 heard evidence that Dr Norbergs ordered and directed others working at the practice to order drugs from foreign distributors. This included drugs from Quality Specialty Products that were not registered with or approved by the US Food and Drug Administration. A federal jury found her guilty of all 45 criminal charges that were levied against her, including receipt and delivery of misbranded drugs, smuggling goods into the United States, healthcare fraud, and mail fraud.

  9. Dr Fernando Mendez-Villamil, a Miami psychiatrist, handed out "epidemic levels of unneeded antipsychotic drugs—$60 million in false claims," the report notes.

    The doctor wrote nearly 97,000 scripts for powerful drugs to Medicaid patients between 2007 and 2009. That was more than any other doctor for mental health medications in Florida. He also handed out another 47,000 in scripts to seniors in just 2 years. The Florida medical board reprimanded and fined him. He was also kicked out of the Medicaid program.

    Mendez-Villamil was indicted by a federal grand jury and pleaded guilty, and was sentenced to 12 years in prison in 2006. "He was one more swindler in a national epidemic of painkillers and other opioids that doctors and pharmacies are handing to addicts," said Quiggle.

    In New York, Mikhail Zemlyansky "masterminded the largest no-fault auto scheme ever charged," the report said. "His crooked assembly line churned out $279 million of false injury claims from real and phantom car wrecks. New York police officers infiltrated the ring, posing as crash victims."

    Ten doctors and three lawyers were part of the conspiracy. "The doctors sold out their professions to rubber-stamp bogus crash treatments," the report said. Zemlyansky set up a string of sham medical clinics. He installed physician Tatyana Gabinskaya as operator of seven clinics. She earned $10,000 each month just to sign false medical paperwork for phony or inflated claims.

    Dr Gabinskaya was sentenced to 1 year and 1 day in prison, and was ordered to forfeit $69,384 and to pay restitution to the victims of her crimes. Sentencing is still pending against 30 other defendants, who face possible sentences of 30-70 years in prison…

    Physicians agree that crooked colleagues cause patients to distrust and lose respect for the medical profession. "Trust is the fundamental basis of our relationship with patients, and we are losing it because of unscrupulous doctors," one physician said in response to a Medscape report about the case of Farid Fata, MD. He was sentenced last July to 45 years in prison for administering excessive or unnecessary chemotherapy to hundreds of patients over a 6-year period, and for billing Medicare and private insurers for $17 million in fraudulent claims.

  10. thank you very much for sharing this informative post.