Heather Alfonso is a villain in this scandal, make no mistake about it, but she had plenty of help especially from Big Pharma and the medical community. The damage she has done far exceeds the penalties she has been assessed. However, the thousands of nameless and faceless patients who died from opioids can no longer speak for themselves.
The Payoff
The release from the Department of Justice (District of Connecticut), November 26, 2019, states the essence of this scandal quite succinctly:
“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. It was a sort of “reward.” In many instances, the dinner programs were only attended by Alfonso and an Insys Therapeutics sales representative [my italics] In other instances, the programs were attended by CPHTC [Comprehensive Pain and Headache Treatment Centers] staff and Alfonso’s friends, none of whom had licenses to prescribe controlled substances.”
Why these kickbacks? Because Alfonso prescribed more than $2.5 million in fentanyl spray made by Insys [Tradename: Subsys], in claims submitted to Medicare.
Subsys has only one, specific approval by the Food and Drug Administration (FDA), for the treatment of end-stage cancer pain. Not one of Alfonso’s “patients” had cancer.
Double-Dipping
The “speaking engagements,” bought and paid for by Insys came about while Alfonso was also employed by The Comprehensive Pain and Headache Treatment Centers. Most anytime Alfonso could get away from her job, she was paid $1,000 for simply having lunch with the drug rep. She wrote down names of medical providers supposedly in attendance at those meetings and blatantly lied that she had great results in diminishing the pain and suffering of patients. It was all a sham.
The sham meetings “indirectly justified” Alfonso’s Medicare billings.
Eventually, the Federal government shut down Insys Therapeutics, slapping the company with $225 million in penalties. As a result of fines and litigation, Insys declared bankruptcy. The founder of the company, John Kapoor long with his executive team were charged by a federal jury for bribery and other penalties.
Despite the penalties imposed on Insys, Heather Alfonso was still subject to criminal and civil penalties.
The judge in the case could have jailed Alfonso but instead, Alfonso has been ordered to repay the more than $2.5 million she and Insys ultimately billed to Medicare. Despite her salary as an advanced R.N. practitioner plus the more than $83,000 she “earned” as a speaker at the sham luncheons, she is hardly a wealthy person. The $2.5 million penalty will most likely force her to work for the rest of her life to repay the debt.
Since the unethical decision she made to shill for the Big Pharma company will obviously impact her standing as an R.N., there is no telling how or how long it will take Alfonso to come up with the money.
What cannot be retrieved here are the lives lost and ruined by the fentanyl addictions Insys encouraged. Medical practitioners such as Heather Alfonso knew exactly what they were doing; they were sharing in a scam, pocketing the bribe money and addicting people to opioids they absolutely did not need.
No Ethics
From top to bottom, there were no ethical considerations by Insys, its executives, their sales reps, the medical professionals they bribed and undoubtedly, many of the patients.
That the Insys people, all of them, had no scruples is a given, however, the true linchpins were the medical professionals who could have done something, stood up for something – and didn’t. They saw only money, lots of it, and the chance to cash in on the misery of others. As there was no oversite and no checks and balances, it was up to each professional approached to either resist addicting – and potentially killing patients, or to decline. Alfonso, never ethically trained, caved in and took the money. Money was her need and her drug of choice. For a while, she was on a “high.”
For an unethical portion of the healthcare system, Medicare has been the gift that keeps on giving. The behavior of some practitioners is as though Medicare is an unlimited pot of gold that has magically appeared from nowhere. The same patients they treat contributed, indeed, the same pot of gold they see, was also put there by them; the taxpayers. It is an easy rationalization. Ultimately, the rationalization in this case, cost lives. There is no justification on this earth for what was done to the affected patients.
