Top executives of a drug company with ties to a Riverside pain clinic doctor face federal racketeering charges for allegedly conspiring to bribe physicians to unnecessarily prescribe a powerfully addictive opioid medication and defraud insurance companies.

On Nov. 8, a federal grand jury in Massachusetts handed down an indictment charging six executives from Insys Therapeutics Inc. with racketeering, mail and wire fraud and conspiring to violate anti-kickback laws.

Insys Therapeutics Inc. makes the drug Subsys, a highly addictive drug containing fentanyl, which was developed exclusively to treat breakthrough pain in cancer patients. 

Federal prosecutors claim that the six Insys executives conspired to bribe pain clinic doctors – via a sham “speakers program” — to prescribe Subsys to non-cancer patients.

When insurance companies balked at paying for the drug when it was used to treat non-cancer patients, the executives allegedly set up a system where employees “were taught how to mislead and deceive insurers regarding [patients’] employment, patient diagnoses and tried and failed medications” in order to obtain prior payment authorization from insurers and pharmacy benefit managers.

If convicted, the defendants face up to 20 years in federal prison and a fine of $250,000 for the racketeering charges.

Insys Therapeutics Inc. ran afoul of the state of Illinois in August when the Illinois Attorney General filed suit to bar Insys from selling its products in the state and to fine them for deceptively marketing Subsys.

That lawsuit named Dr. Paul C. Madison, who is affiliated with Riverside Pain management at 28 E. Burlington St., as a medical practitioner whom the company targeted to prescribe Subsys, paying him tens of thousands of dollars in fees for what the attorney general termed sham speaking engagements at Chicago-area restaurants.

The Illinois Department of Financial and Professional Regulation suspended Madison’s medical license on Nov. 28, one month after suspending the license of another doctor at the same Riverside clinic.

The clinic, which is managed by Dr. Joseph Giacchino – whose medical license was revoked by the state in 2011 – continues to operate.

While Madison is not specifically mentioned in the Massachusetts indictment, he appears to be one of 10 medical practitioners cited in the federal indictment as examples of how Insys Therapeutics allegedly would court and bribe doctors to prescribe Subsys.

Practitioner No. 6 in the indictment is identified as an Illinois pain management doctor who became a sales target for Insys in 2012. 

A sales representative sent an email to one of the indicted executives in 2012, stating that Practitioner No. 6 “runs a very shady pill mill and only accepts cash. He sees very few insured patients but does write some [prescriptions for a competitor product]. He is extremely moody, lazy and inattentive. He basically just shows up to sign his name on the prescription pad, if he shows up at all.”

That exact description appears in the Illinois Attorney General’s lawsuit against Insys, describing an Insys sales rep’s interactions with Madison. In its lawsuit, the Illinois Attorney General described Madison as the top prescriber of Subsys in Illinois, accounting for 58 percent of all Subsys prescriptions written in the state.

According to the federal indictment, Insys paid Practitioner No. 6 a total of $70,800 in “speaker program bribes and kickbacks” between February 2013 and July 2015.

None of the doctors used to illustrate Insys’ business practices has been charged with any wrongdoing and are not named as defendants as part of the federal indictment involving Insys executives.

Madison, however, remains under federal indictment in a 2012 case filed in Illinois alleging that he submitted millions of dollars in false medical bills to insurance companies and a federal worker’s compensation program between 2005 and 2009.