Florida, the reputed epicenter of the opioid crisis, served as fertile ground for a pharmaceutical company accused of bribing doctors to prescribe a powerful fentanyl spray.
The Sunshine State topped the nation in 2014 and 2015 for patients and claims to Medicare for the medicine manufactured and marketed by Arizona-based Insys Therapeutics, according to the Centers for Medicare and Medicaid Services. The company paid Florida physicians more than $2.1 million from August 2013 through 2015 through what prosecutors say was a sham promotional speakers program, a Palm Beach Post analysis of Medicare data shows.
Some of the top Subsys prescribers in the nation — as well the top doctors paid by Insys — were in Florida.
In Palm Beach County, the doctor most associated with Subsys is Bart Gatz of Greenacres.
Gatz received $229,000 from August 2013 through 2015 — the seventh highest in the nation. Gatz generated more than $4.1 million in payments to Insys from Medicare alone during that period, according to the government figures.
Insys frequently targeted doctors with troubled pasts to speak on behalf of its product, which is up to 100 times more powerful than morphine, The Post found. None has been charged or sued in connection with Insys.
Gatz’s former practice paid $1.1 million to settle allegations he billed Medicare for unnecessary nerve conduction tests.
Besides Gatz, a Lake Worth doctor who took tens of thousands in speaker fees has settled several malpractice cases, including four in which patients claimed they ended up paralyzed after treatment. A Coral Springs physician paid by Insys is on probation with the Florida Department of Health after it determined that he overprescribed narcotics.
Chun: ‘Everything by the books’
Only one Florida doctor made more money from Insys than Gatz.
Dr. Steven Chun of Sarasota received nearly $270,000 from August 2013 through 2015, placing him third on the list of the country’s highest-paid physicians by Insys.
The amount of money Chun received is a close match to a doctor described in the criminal indictment against Insys executives only as Practitioner No. 9. Federal prosecutors say that besides paying that doctor kickbacks and bribes through a speakers program, Insys hired Practitioner No. 9’s girlfriend as an area business liaison — basically staffing his clinic with an employee paid for by the pharmaceutical company.
Chun settled a federal whistleblower suit in 2014, paying $750,000 to the Department of Health and Human Services after allegations he billed Medicare for more complex medical exams than he actually performed. He agreed to a three-year integrity agreement, which imposed obligations ranging from an independent review of his books to posting a sign in his office for a hotline to report suspected fraud. Not following the agreement could have caused him to lose approval to participate in federal health-care programs.
Gatz has been working under an integrity agreement with similar obligations since 2016 after the Medicare allegations were settled. He said the tests were incomplete, not unnecessary, as the government alleged.
When reached by phone, Chun said, “I don’t know where you got my name. We did everything by the book.” His Florida license is clear and active with no disciplinary action.
Other Florida doctors who got paid by Insys are fighting off lawsuits for prescribing the drug for patients who died or became addicted.
Dr. Orlando Florete pulled in $120,000 from Insys and was the prescribing physician to Carolyn “Susie” Markland, who received a dose of Subsys at his office and died the next morning. Florete settled a malpractice claim with Markland’s husband for $200,000.
Lubin: ‘This whole thing is a nightmare’
Insys paid $152,000 to Dr. Edward Lubin of Winter Haven from August 2013 through 2015.
Wayne Sprinkler Co. of Ocoee in 2016 sued Lubin and Insys, claiming the wife of an employee covered under its health plan became addicted to the fentanyl spray. The sprinkler company said Insys lied that the woman had cancer to get pharmacy approval for the fentanyl spray. Lubin’s office eventually said she really had lower back pain, according to the lawsuit.
Lubin wrote 16 Subsys prescriptions for the patient in 2014, the same year he received about $100,000 from Insys for speaking fees and travel.
“I can tell you I took not one penny from the company for any prescribing habits,” said Lubin, who now works in Largo.
“This whole thing is a nightmare because well-meaning physicians who wanted to speak on behalf of proper treatment for cancer patients are being sucked up in this scandal inappropriately.”
He said when he learned of Insys’ legal troubles, he was shocked. “I had no idea,” Lubin said. “I’m like hundreds of thousands of people in Florida who are saying, ‘Oh my God.’”
The sprinkler lawsuit eventually was settled, Lubin said, “for a nuisance fee.”
Lubin said he almost exclusively prescribed Subsys for cancer patients, used a slide show for his presentations and that his talks were attended by medical professionals. He said no law enforcement investigators ever spoke to him about Subsys.
“I spoke a lot for the company because I believe in educating nurses and doctors in the appropriate treatment for cancer patients,” he said.
“Supposedly, the speaker program was transmogrified into debauchery,” he said.
Rogers: Malpractice claims, paralysis
In Palm Beach County, Insys tapped one doctor for its speaker program who has faced multiple malpractice claims from patients.
Dr. Anthony G. Rogers of Palm Beach Pain Management in Lake Worth was paid nearly $78,000 by Insys over about 2½ years.
He has been accused at least four times of leaving patients either paralyzed or with permanent damage to their spinal cords after treating them, state insurance, health department and court records show. He did not return calls for comment.
Four malpractice claims, including some involving paralysis, from 2002 to 2014 were settled by Rogers for $250,000 each.
Rogers also has been accused of overprescribing. In the mid-‘90s, a state Health Department complaint says he prescribed a back pain patient 60 OxyContin pills (80 mg) each day as well as other opioids. The patient testified in Rogers’ support at a hearing. Rogers was disciplined with a $1,000 fine for keeping inadequate medical records after an administrative judge overruled DOH’s findings on appeal, dropping the overprescribing allegation. DOH strenuously objected to the ruling.
Wand: ‘Inappropriately and excessively’ prescribed
And then there is Dr. Paul Wand, a neurologist just across the county line in Coral Springs.
Wand received nearly $99,000 in a 2 ½-year span from Insys before his authority to prescribe controlled substances was revoked in a 2016 settlement with the Florida Board of Medicine. The complaint, filed against him in 2009, stated that he “inappropriately and excessively” prescribed a variety of opioids, including fentanyl patches, as well as anti-anxiety drugs to patients.
Wand said the government’s data on the amount of money Insys paid him is “grossly inflated.” He also said that he was not treated fairly by the medical board, which applied a standard of care that wasn’t applicable.
One doctor with a clean disciplinary and malpractice record who got paid by Insys was Boca Raton neurologist Dr. Lisa Banchik. She received nearly $72,000 from August 2013 through 2015.
Banchik, however, is mentioned in a whistleblower complaint against Cephalon, which resulted in criminal and civil fines against Cephalon in 2008 for off-label marketing of its fentanyl lollipop and two other drugs.
The whistleblower notes that Banchik was targeted to sell the fentanyl lollipop, Actiq, because she wrote a large number of opioid prescriptions. Actiq, like Insys’ fentanyl spray, is limited by the FDA to only patients suffering break-through cancer pain. Gatz and Rogers also were visited by Cephalon reps. Banchik did not return calls for comment.
After Banchik was invited by Cephalon to its national consultants’ meeting in San Diego, she told a company salesperson she would try to prescribe Actiq more and introduced him to a patient of hers who had been prescribed the lollipop, according to the whistleblower’s complaint. The patient suffered from back pain.
PAY TO PRESCRIBE? THE FENTANYL SCANDAL