Brett Szymanski knew what he was doing was wrong.
As a sales representative for Arizona-based Insys Therapeutics, Szymanski was setting up paid speaker programs for a doctor who had written dozens of prescriptions for Subsys, a fentanyl spray that cost about $19,000 for a month’s dose.
Often, no one showed up for the programs, but the company would still pay the doctor as a reward, Szymanski said in US District Court in Boston on Wednesday. His testimony came on the third day of the landmark racketeering trial against five former company executives and directors, including the company’s founder.
Assistant US Attorney K. Nathaniel Yeager asked Szymanski, who worked in Insys’s Michigan office, why he kept booking speaker programs that clearly were a form of bribery.
“This was my first pharmaceutical job,” said Szymanski, who was in his mid-20s at the time. “I had wanted to do it for a long time. I was starting to do well, to learn the business.”
And the money was too good, Szymanski acknowledged. By the time Szymanski left Insys in 2016, he had made between $1.5 million and $2 million peddling Subsys, a fentanyl spray that had been approved by federal regulators to treat the severe pain of cancer patients but was being prescribed by doctors and other health care professionals to people who did not need it. The government alleges that in exchange for writing prescriptions, they received lucrative speaking engagements from Insys.
Szymanski was the second sales representative to testify against the company’s founder, John Kapoor; Sunrise Lee and Joseph Rowan, former regional sales directors; Michael Gurry, the former vice president of managed markets; and Richard Simon, former national director of sales.
Prosecutors have said that the defendants participated in a scheme to provide bribes and kickbacks to medical professionals who prescribed large amounts of Subsys, a plan that made the drug the leading brand in the market and created a fortune for the company but left an untold number of addicted patients in its wake.
Defense attorneys have told the jury the prosecution’s case is riddled with distortions and inaccuracies and relies on witnesses who made deals to avoid criminal prosecution.
Szymanski, who was granted immunity, described a high-pressure environment in which executives and sales directors, including Lee, pushed sales representatives to schedule as many speaker programs as possible for doctors with a high rate of prescriptions. Often, only friends or employees of the doctor would show up, if anyone at all, but Szymanski said he had to fill out a sheet showing the signature of those who had attended.
Szymanski testified that he asked the company’s vice president of sales, Alec Burlakoff, what to do if no one came to hear a speaker talk.
“ ‘I don’t care if people show up. Go to a playground and get signatures,’ ” was Burlakoff’s reply, Szymanski said.
Sales representatives were told to cut off programs for doctors who did not write enough prescriptions, Szymanski said.
Lee, who supervised Szymanski, urged him to schedule multiple programs for one especially high-prescribing doctor in Michigan, Gavin Awerbuch, according to the testimony.
“I need him to be as busy as he wants to be,” Lee wrote Szymanski in one e-mail. “If you can schedule up to three programs a week for him that would be ideal.”
In the spring of 2014, Szymanski drove to Awerbuch’s office and saw several police cars out front. Four years later, Awerbuch would be convicted of health care fraud and sentenced to 32 months in prison for writing improper prescriptions for Subsys.
During cross-examination, Lee’s lawyer, Peter Horstmann asked Szymanski whether he had used his skills as a salesman when he met with prosecutors as a way to avoid prosecution for his own criminal behavior.
“You had a sales pitch in mind, right?” Horstmann said.
“No,” Szymanski said.
Kosta S. Stojilkovic, one of Kapoor’s attorneys, tried to undercut Szymanski’s testimony by asking about a doctor who received $33,000 from Insys for speaking engagements in one year even though he never wrote any prescriptions for Subsys during that time.
“Based on what you [testified], that wouldn’t have happened,” Stojilkovic said.
“Typically, no,” Szymanski said.