Doctors Accepting Bribes, Betraying Patients

On June 9, FBI agents arrested two former drug company employees for allegedly running a brazen scheme to bribe doctors to prescribe millions of dollars' worth of a powerful synthetic opioid. Complaints filed in federal court by the FBI paint a disturbing picture of doctors succumbing to greed and violating their duty to act only in the best interests of their patients.[1],[2],[3]

Defendants Jonathan Roper and Fernando Serrano formerly worked at Insys Therapeutics.[4] Insys markets only one product: fentanyl spray (SUBSYS), a rapidly acting, highly potent, dangerous opioid sprayed under the tongue.[5] It is approved solely for treating pain in cancer patients who are not responding adequately to other opioids.[6]

The government alleges that from 2013 to 2015, Roper and Serrano paid speaking fees to doctors, purportedly to educate other health care providers about SUBSYS. But many of the educational programs were phony, involving social gatherings and no education. Emails written by Roper to his sales team explicitly signaled that in exchange for receiving speaking fees for the sham educational programs, as well as for being wined and dined at expensive restaurants, doctors were expected to prescribe SUBSYS.

Likewise, Serrano allegedly told one unidentified doctor, who was a company-paid speaker and is now a government witness, that the doctor needed to help Serrano out by writing prescriptions for SUBSYS.

Unfortunately, the defendants found doctors who were more than willing to play ball at the expense of their patients. For example, two Manhattan-based doctors recruited by the defendants — identified by the government only as "Doctor-1" and "Doctor-2" — were two of the top recipients of Insys speaking fees in the U.S. in 2014, receiving $147,000 and $112,000, respectively.

The company’s investment in these doctors appears to have paid handsome dividends: Together they accounted for $2.6 million worth of SUBSYS prescriptions reimbursed by Medicare and more than $5 million worth of prescriptions reimbursed by private insurance, making them among the top SUBSYS prescribers in the U.S. in 2014. The prolific prescribing of SUBSYS by Doctor-1 is even more troubling given that the doctor is not a cancer specialist, suggesting that many prescriptions were for patients with noncancer pain.

The alleged conduct of Doctors-1 and -2, if true, was reprehensible. By prescribing a dangerous and highly restricted opioid like fentanyl in exchange for bribes from Insys employees, they not only violated federal kickback laws but also potentially endangered patients' lives. Hopefully, the Justice Department will identify and file charges against Doctors-1 and -2, and if they are found guilty, the New York state medical board will permanently revoke their medical licenses.

References

[1] United States Attorney’s Office, Southern District of New York. Press release: Former pharmaceutical company employees arrested for participating in fentanyl kickback scheme. https://www.justice.gov/usao-sdny/pr/former-pharmaceutical-company-employees-arrested-participating-fentanyl-kickback-scheme. Accessed June 21, 2016.

[2] United States of America v. Jonathan Roper. S.D.N.Y. June 8, 2016. https://www.justice.gov/usao-sdny/file/865946/download. Accessed June 21, 2016.

[3] United States of America v. Fernando Serrano. S.D.N.Y. June 8, 2016. https://www.justice.gov/usao-sdny/file/865951/download, Accessed June 21, 2016.

[4] Thomas K. Drug maker’s former employees accused of shady dealings with doctors. June 10, 2016. New York Times. http://www.nytimes.com/2016/06/11/business/drug-makers-former-employees-accused-of-shady-dealings-with-doctors.html?_r=0. Accessed June 21, 2016.

[5] Insys Therapeutics. Approved products. http://www.insysrx.com/products/approved. Accessed June 21, 2016.

[6] Insys Therapeutics. Label: fentanyl spray (SUBSYS). December 2014. https://dailymed.nlm.nih.gov/dailymed/getFile.cfm?setid=18a413e9-11e0-4a8f-86c0-d33b37b7b771&type=pdf&name=18a413e9-11e0-4a8f-86c0-d33b37b7b771. Accessed June 21, 2015.