First major pharmaceutical executive convicted on criminal charges related to opioid crises

Insys founder found guilty of racketeering in connection with bribes to prescribe potent opioid spray.

On past Monitor Monday programs, we have reported on John Kapoor, the former CEO of opioid giant Insys Therapeutics Inc., who has been under indictment since October 2018 for alleged violations of the Anti-Kickback Statute (AKS), which prohibits medical providers from paying or receiving kickbacks, remuneration, or anything of value in exchange for referrals of patients who will receive treatment paid for by government healthcare programs like Medicare and Medicaid.

The law, often referred to as AKS, is designed to keep medical treatment decisions free from the influence of potential monetary gain. Violations of AKS can also be violations of the False Claims Act, which allows private citizen whistleblowers to report on fraud against the government and share in the recovered amount.

Kapoor was charged with paying hundreds of thousands of dollars to doctors in exchange for their prescribing a spray called Subsys that contained fentanyl, a powerful opioid; Subsys is 100 times stronger than morphine and can cost tens of thousands of dollars a month. The scheme was brought to light by seven whistleblowers, most of whom were former employees of Insys. In August 2018, the government settled its civil case against Insys for $150 million, with the individual whistleblowers receiving a share of the recovery.

The parallel criminal case, in which Kapoor was charged with racketeering, a charge generally reserved for organized crime bosses, continued. Kapoor pleaded not guilty to all charges in November 2018.

The criminal case went to trial, and on May 2, after 15 days of deliberations, the jury found Kapoor and four co-conspirators guilty of racketeering. The jury found that Insys paid doctors to prescribe Subsys and then lied to insurance companies to ensure that their actions were concealed. Although the sentencing hearing has not yet been scheduled, Kapoor, who is 76 years old, faces up to 20 years in prison. 

John Kapoor is the first major pharmaceutical executive to be convicted on criminal charges that relate to America’s opioid crises and overdose deaths. Other companies and their executives have been accused of similar practices.

In the trial, which lasted 10 weeks, the government portrayed Kapoor as caring about profits over the well-being of patients. According to the prosecution’s case, Insys allegedly sought doctors who already were above-average prescribers of opioids and invited them to participate in the company’s “speakers’ program.” As long as they continued to prescribe Subsys, doctors were paid high sums for their speeches, even if nobody showed up, federal prosecutors argued.

Insys also allegedly created a call center where its employees pretended to be employed by the doctors in the speakers’ program. Those employees allegedly then fabricated diagnoses to ensure that insurance carriers would cover the costs of the opioid drug.

At trial, Kapoor’s attorneys argued that he was uninvolved in and unaware of the illegal schemes, blaming several other former Insys executives, some of whom had already pleaded guilty in connection with related criminal actions. The jury seemingly rejected this argument.

The scandals have put Insys in dire financial straits, with the company announcing that “there is substantial risk surrounding our ability to continue … primarily due to mounting legal costs and uncertain legal settlement exposures.” The company’s stock has fallen 90 percent, compared to its 2015 all-time-high.

Several other former Insys executives, as well as former executives of other companies, are facing their own legal challenges. We here at RACmonitor will continue to keep you informed as to the various cases progress, in what has been described as a year of reckoning for executives of the pharmaceutical companies who have made and continue to make billions from opioids.

 

Comment on this article

Facebook
Twitter
LinkedIn

Mary Inman, Esq.

Mary Inman is a partner and co-founder of Whistleblower Partners LLP, a law firm dedicated to representing whistleblowers under the various U.S. whistleblower reward programs. Mary and her colleagues have pioneered a series of successful whistleblower cases against prominent health insurers, hospitals, provider groups, and vendors under the False Claims Act alleging manipulation of the risk scores of Medicare Advantage patients. Mary is a recognized expert and frequent author, commentator, and speaker on frauds in the healthcare industry, particularly those exposed by whistleblowers. Mary is a member of the RACmonitor editorial board and a popular panelist on Monitor Monday.

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

Decoding 2025 OPPS Charge Capture and Coding Complexities: Strategies for Success

Decoding 2025 OPPS Charge Capture and Coding Complexities: Strategies for Success

Prepare your organization for the 2025 OPPS updates with expert insights from Tiffani Bouchard, CCS, CRCR, a Revenue Integrity Professional with over 30 years of experience. This webcast will address critical challenges in charge capture and coding, providing clarity on APC policies, C-APC packaging, exclusions, and payer-specific requirements. Attendees will learn actionable strategies to ensure compliance, optimize reimbursement, and mitigate risks of claim denials. Gain the knowledge needed to implement updates effectively, educate your team, and maintain seamless revenue cycle operations in the face of evolving OPPS complexities.

January 29, 2025
Enhancing Outcomes with CDI-Coding-Quality Collaboration in Acute Care Hospitals

Enhancing Outcomes with CDI-Coding-Quality Collaboration in Acute Care Hospitals

Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.

November 21, 2024
Comprehensive Inpatient Clinical Documentation Integrity: From Foundations to Advanced Strategies

Comprehensive Outpatient Clinical Documentation Integrity: From Foundations to Advanced Strategies

Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.

September 5, 2024

Trending News

Featured Webcasts

Navigating the 2025 Medicare Physician Fee Schedule: Key Changes and Strategies for Success

Navigating the 2025 Medicare Physician Fee Schedule: Key Changes and Strategies for Success

The 2025 Medicare Physician Fee Schedule brings significant changes to payment rates, coverage, and coding for physician services, impacting practices nationwide. Join Stanley Nachimson, MS., as he provides a comprehensive guide to understanding these updates, offering actionable insights on new Medicare-covered services, revised coding rules, and payment policies effective January 1. Learn how to adapt your practices to maintain compliance, maximize reimbursement, and plan for revenue in 2025. Whether you’re a physician, coder, or financial staff member, this session equips you with the tools to navigate Medicare’s evolving requirements confidently and efficiently.

January 21, 2025
Patient Notifications and Rights: What You Need to Know

Patient Notifications and Rights: What You Need to Know

Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.

December 5, 2024
Navigating the No Surprises Act & Price Transparency: Essential Insights for Compliance

Navigating the No Surprises Act & Price Transparency: Essential Insights for Compliance

Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks.  Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.

November 19, 2024
Post Operative Pain Blocks: Guidelines, Documentation, and Billing to Protect Your Facility

Post Operative Pain Blocks: Guidelines, Documentation, and Billing to Protect Your Facility

Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.

October 24, 2024

Trending News

Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →

CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24