RI Doctor Charged With Healthcare Fraud, Receiving Kickbacks
Friday, February 03, 2017
A Rhode Island doctor has been charged with healthcare fraud and receiving kickbacks in connection with prescriptions for "powerful, expensive and highly-addictive" fentanyl spray, according to the U.S. Attorney's office in Providence.
Jerrold Rosenberg, 62, of North Providence and Jamestown was charged with healthcare fraud, conspiracy to solicit or accept kickbacks, and receipt of kickbacks related to Rosenberg’s prescription of a fast-acting, powerful, and highly-addictive version of the opioid drug Fentanyl that is administered as an under-the-tongue spray.
The 19-count federal indictment was handed down by U.S. District Court in Providence on Thursday, February 2.
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The indictment alleges that, owing to its potency and potential for addiction, the Fentanyl spray is approved by the federal Food and Drug Administration solely for “the management of breakthrough cancer pain in . . . patients who are already receiving and who are already tolerant to opioid therapy for their underlying persistent cancer pain.” The spray is extremely expensive, with the cost of a thirty-day supply ranging from almost $2,000 to over $16,000. As a result, insurance companies, including insurers covering Medicare patients, impose strict requirements and limitations that must be met before the Fentanyl spray will be covered. Typically, these limitations require that a doctor submit paperwork showing that the patient has active cancer, that the spray is intended to treat breakthrough pain from this cancer, and that other powerful opioid drugs have been tried, without success.
It is alleged that Rosenberg repeatedly submitted false and fraudulent documentation to insurers to get them to approve and pay for the Fentanyl spray, including authorization forms and so-called letters of medical necessity that falsely claimed patients had cancer and related pain. He did this for patients who never had cancer at all, as well as cases where the patient’s history of cancer was long past and/or unrelated to any pain for which they sought treatment with Rosenberg.
In 2014, GoLocal reported how the RI Department of Heath had reprimanded Rosenberg:
Licensed Rhode Island physician Jerrold Rosenberg, M.D, who was disciplined by the Rhode Department of Health (HEALTH) in September for inappropriately prescribing painkillers, was listed among the highest paid doctors in the country for speaking fees from Insys Therapeutics -- who made one of those painkillers, Subsys -- according to a report by the New York Times.
Read: HEALTH Disciplinary Action HERE
"Another top Insys speaker, Dr. Jerrold Rosenberg of Rhode Island, was reprimanded in September for inappropriately prescribing painkillers, including Subsys," wrote the NYT's Katie Thomas.
The NYT reported that five of the 20 physicians who received the most money from Insys recently faced legal or disciplinary action, including three who were said to have inappropriately prescribed painkillers.
The NYT reported that in addition to paying high-prescribing doctors to speak on behalf of Subsys, Insys also hired the doctors’ family members. In 2013, Dr. Rosenberg’s son, Abraham, was a top sales representative for the company. READ MORE HERE
In addition to the healthcare fraud scheme, it is alleged that Rosenberg conspired to seek and receive kickbacks from the manufacturer of the Fentanyl spray. These took the form of “sham” speaker programs, where, instead of a legitimate lecture about the Fentanyl spray, Rosenberg received company-paid dinners at expensive restaurants and speaking fees, on occasion dining only with family members or representatives from the drug company. In several instances, attendance forms for these events were forged to show that medical professionals had been present for a supposedly legitimate promotional discussion, when in fact they had not. The indictment alleges that these speaker programs were, in fact, a cover for payments by the drug company to Rosenberg, to induce him to write more, and higher, prescriptions for the spray.
Finally, it is alleged that Rosenberg’s son worked as a sales representative for the drug company that manufactured the Fentanyl spray, where he was responsible for marketing the drug to a number of physicians, including his father. The sales commissions of Rosenberg’s son were tied to the number of prescriptions written by doctors, and it is alleged that Rosenberg wrote more prescriptions for the Fentanyl spray to provide a financial benefit to his son.
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