In March of 2013, Gordon Freedman, a doctor on Manhattan’s Upper East Side, fielded a request from a regional sales manager for the manufacturer of Subsys, a spray form of the highly addictive painkiller fentanyl.
Dr. Freedman was already a top prescriber of Subsys and also one of the company’s paid promotional speakers. Now the sales manager was telling him the company, Insys Therapeutics, would increase the amount of money it was paying him and asked that he increase the number of new patients he was prescribing Subsys.
“Got it,” Dr. Freedman replied, according to authorities. By 2014, they said, Dr. Freedman had become one of the country’s top prescribers of the painkiller drug — and also the company’s highest-paid speaker.
The exchange between the doctor and Insys was detailed in a federal indictment unsealed on Friday in Manhattan, charging Dr. Freedman, of Mount Kisco, N.Y., and four other New York doctors with participating in a bribery and kickback scheme that prosecutors said sought to increase the drug company’s sales and preyed on unwitting patients.
Insys paid the doctors, in some cases more than $100,000 annually, in return for prescribing millions of dollars’ worth of the company’s painkiller product, the indictment said. It charged that Insys funneled the illicit payments to the doctors through a sham “speakers bureau,” in which the doctors were paid for purportedly giving educational presentations about the drug that, in many cases, were mere social gatherings at high-end Manhattan restaurants.
Such gatherings involved no educational presentation, and attendance sign-in sheets were often forged to include the names of health care practitioners who were not actually present, the authorities said.
“These prominent doctors swore a solemn oath to place their patients’ care above all else,” said Geoffrey S. Berman, the United States attorney for the Southern District of New York. “Instead, they engaged in a malignant scheme to prescribe fentanyl, a dangerous and potentially fatal narcotic 50 to 100 times more potent than morphine, in exchange for bribes in the form of speaker fees.”
Mr. Berman announced the charges along with William F. Sweeney Jr., the head of the F.B.I.’s New York office. The four other doctors charged in the New York case are Jeffrey Goldstein of New Rochelle, N.Y.; Todd Schlifstein of New York City; Dialecti Voudouris of New York City; and Alexandru Burducea of Little Neck, N.Y.
All five defendants pleaded not guilty in federal court on Friday afternoon and were released on $200,000 bond. None of the five responded to reporters’ requests for comment as they left the courtroom.
Mr. Berman’s office also disclosed that two former Insys employees — Jonathan Roper and Fernando Serrano — had pleaded guilty and were cooperating with the federal investigation.
Insys, which is based in Arizona, has come under intense scrutiny over its aggressive marketing of Subsys, a form of fentanyl approved in 2012. Subsys is sprayed under the tongue and approved for use only in patients who have cancer and who experience pain even though they are already on round-the-clock painkillers.
Fentanyl can be deadly if it is prescribed in large doses to someone who has not already become tolerant to opioids, yet the drug has been widely sold to a variety of patients. An analysis in 2014 for The New York Times by the research firm Symphony Health, for example, found that just 1 percent of prescriptions for Subsys were from oncologists.
Already, the federal authorities in Boston have brought charges against Insys’s founder and former chief executive, John Kapoor, as well as against several other top executives and sales managers. They have all pleaded not guilty.
The New York indictment offers further evidence that investigators have broadened their inquiry into doctors who were prescribing the drug to patients. Earlier this month, another top prescriber, Jerrold Rosenberg of Rhode Island, was sentenced to more than four years in prison after admitting he took kickbacks from Insys.
The company did not respond to a request for comment on Friday.
The indictment unsealed on Friday charged that the drug firm had used its speakers program “to induce a select group of practitioners,” including the five doctors charged in New York, to prescribe large volumes of the fentanyl spray. The selected doctors were often referred to within the company as “top docs,” the indictment said.
The company’s executives meticulously “tracked and circulated statistics for each speaker,” the indictment noted.
It also said Mr. Roper, then the district sales manager for a territory that included Manhattan, emailed sales representatives, reminding them to repeatedly tell their speakers of “one simple guideline” — if they did not write prescriptions, there would be no speaking engagements. As he put it, according to the indictment: “NO SCRIPTS. NO PROGRAMS.”
One of the defendants, Dr. Goldstein, sometimes did not even stay for a meal at the programs where he was the featured speaker, instead ordering food from the restaurant and leaving with it, according to the indictment.
Before one program in 2014, the indictment added, Dr. Goldstein wrote to an Insys sales representative, asking, “Is dinner take out or we expecting peeps?”