Indictment alleges fraud and kickbacks in connection with prescriptions for a powerful and highly-addictive fentanyl spray
PROVIDENCE, R.I. - A 19-count federal indictment filed in U.S. District Court in Providence charges Jerrold N. Rosenberg, 62, of North Providence and Jamestown, R.I. with health care 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.
Rosenberg was taken into custody today by agents from the Department of Health and Human Services Office of Inspector General, and the Medicaid Fraud Control and Patient Abuse Unit of the Rhode Island Department of Attorney General, on a federal warrant issued by the Court. Rosenberg was arraigned before U.S. District Court Magistrate Judge Lincoln D. Almond and released on unsecured bond.
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 addition to the health care 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.
An indictment is merely an allegation and is not evidence of guilt. A defendant is entitled to a fair trial in which it will be the government’s burden to prove guilt beyond a reasonable doubt.
The investigation was conducted by the United States Attorney’s Office, U.S. Department of Health and Human Services Office of Inspector General, and the Medicaid Fraud Control and Patient Abuse Unit of the Rhode Island Department of Attorney General.
The case is being prosecuted by Assistant U.S. Attorneys Lee H. Vilker and Zachary A. Cunha.
Source: U.S. Department of Justice, Office of the United States Attorneys
