The U.S. Attorney’s Office of the District of Connecticut has announced that an Advanced Practice Registered Nurse (APRN) practicing in the state has admitted to receiving $83,000 in kickbacks—mostly as a speaker at dinner programs—by an unnamed drug manufacturer. The press release states that Heather Alfonso was a “heavy prescriber” of a drug used to treat cancer pain. They noted that a review of Medicare Part D prescription drug events for prescribers of the drug showed that Alfonso was responsible for more than $1 million in claims and was the highest prescriber of the drug in Connecticut. However, the government found through interviews with Alfonoso’s Medicare Part D who were prescribed the drug, revealed that most of them did not have cancer, but were taking the drug to treat their chronic pain.
This latest press release is notable for several reasons:
First, Connecticut recently passed a law requiring manufacturers to report their transfers of value made to APRNs practicing in Connecticut. This group includes nurse practitioners, clinical nurse specialists, nurse anesthetists, and nurse midwives. APRNs are excluded from the reporting obligations under the Federal Physician Payments Sunshine Act, but Connecticut passed this disclosure requirement as part of a new initiative allowing APRNs to practice and prescribe independently of physicians. This law was originally supposed to go into effect July 1, 2015, but was recently pushed back to 2017. This latest enforcement action illustrates that the reporting law may have been passed with kickbacks to APRNs in mind.
Second, this announcement is the latest of many in the last week alone by the government targeting Medicare Part D. Last week, the Department of Health and Human Services announced the largest ever Medicare Fraud Strike Force sweep, with charges brought against 243 individuals for approximately $712 million in billings. More than 44 of the defendants arrested were charged with fraud related to Part D. The HHS Office of Inspector General a couple of days ago also released two reports that similarly target Part D fraud. “OIG has seen an increase in Part D fraud complaints,” the agency states. “As such, OIG has made Part D fraud a top priority.” The roll-out of several Medicare Part D related enforcement actions over the last few days clearly indicates that fact.
Third, the government’s focus on the prescriber side of the kickback equation signals their increasing likelihood to bring enforcement actions against individuals, rather than (or in addition to) the traditional focus on companies. While the Department of Justice and state attorneys have long said that the increased data streams allow for more targeted enforcement actions, we are now seeing the fruits of their data analysis.
Fourth, this announcement targets speaker programs–arrangements the DOJ has noted are “prone to abuse.” The Connecticut U.S. Attorney’s Office reveals that Alfonso was paid $83,000 by a drug manufacturer, which she admitted influenced her prescribing of the drug. The press release states that she was a speaker for more than 70 dinner programs at a rate of approximately $1,000 per event. “In many instances, the dinner programs were only attended by Alfonso and a sales representative for the drug manufacturer,” the release states. “In other instances, the programs were attended by individuals, including office staff and friends, who did not have licenses to prescribe controlled substances. For the majority of these dinner programs, ALFONSO did not give any kind of presentation about the drug at all.”
Finally, the government’s focus on pain meds–and looking to stem their abuse–is another notable trend.