Newark, New Jersey - A doctor who practiced in New Jersey and Pennsylvania was charged in an indictment unsealed Tuesday for his alleged participation in a scheme to receive bribes and kickbacks from a pharmaceutical company in exchange for prescribing large volumes of a powerful fentanyl narcotic.
Assistant Attorney Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Craig Carpenito of the District of New Jersey, Special Agent in Charge Gregory W. Ehrie of the FBI’s Newark Field Office, Special Agent in Charge Scott J. Lampert of the U.S. Department of Health and Human Services Office of the Inspector General’s (HHS-OIG) Office of Investigations—New York Region and Special Agent in Charge Susan A. Gibson of the Drug Enforcement Administration’s (DEA) New Jersey Division made the announcement.
Kenneth Sun, M.D., 58, of Easton, Pennsylvania, was charged with one count of conspiracy to defraud the United States and to pay and receive health care kickbacks and four counts of receiving health care kickbacks. Sun was arrested this morning and appeared this afternoon before U.S. Magistrate Judge Leda Dunn Wettre of the District of New Jersey. A trial date has not been set.
According to the indictment, Sun owned and maintained a pain management medical practice named Progressive Pain Solutions LLC, which had two locations: one in Phillipsburg, New Jersey, the other in Wind Gap, Pennsylvania. The indictment alleges that Sun solicited and received more than $140,000 in bribes and kickbacks from Insys Therapeutics, a pharmaceutical company based in Arizona, in exchange for prescribing more than 28 million micrograms of Subsys, a powerful opioid narcotic designed to rapidly enter a patient’s bloodstream upon being sprayed under the tongue. Subsys, which is sold by Insys Therapeutics and costs thousands of dollars for a month’s supply, contains fentanyl, a synthetic opioid pain reliever which is approximately 50 to 100 times more potent than morphine. The U.S. Food and Drug Administration approved Subsys solely for the “management of breakthrough pain in cancer patients who are already receiving and who are tolerant to around the clock therapy for their underlying persistent cancer pain”. The indictment alleges that Sun prescribed Subsys to patients for whom Subsys was medically unnecessary, not eligible for insurance reimbursement and/or not desired.
The indictment further alleges that the bribes and kickbacks that Sun received from Insys Therapeutics in exchange for prescribing Subsys were disguised as “honoraria” for educational presentations regarding Subsys that Sun purportedly provided to licensed practitioners. In reality, the indictment alleges, these presentations were a sham: they lacked the appropriate audience of licensed practitioners, there was no presentation about Subsys whatsoever, the same individuals attended over and over again and Sun did not attend some of the presentations at all. Sun caused Medicare to pay more than $847,000 for Subsys prescriptions that were medically unnecessary, procured through the payment of kickbacks and bribes, and not eligible for Medicare reimbursement, the indictment alleges.
An indictment is merely an allegation and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.
This case was investigated by the FBI, HHS-OIG and the DEA. Trial Attorney Rebecca Yuan of the Criminal Division’s Fraud Section is prosecuting the case.
The Fraud Section leads the Medicare Fraud Strike Force, which is part of a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. Since its inception in March 2007, the Medicare Fraud Strike Force, which maintains 14 strike forces operating in 23 districts, has charged nearly 4,000 defendants who have collectively billed the Medicare program for more than $14 billion. In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.