John Kapoor: Insys Therapeutics, RICO Conviction, and 66-Month Sentence

John Kapoor, the founder of Insys Therapeutics, was convicted in May 2019 of racketeering conspiracy for orchestrating a scheme to bribe doctors into prescribing the fentanyl spray Subsys and to defraud insurers into paying for it, and in January 2020 he was sentenced to 66 months in federal prison. The Insys conviction and sentencing of John Kapoor made him the first founder of a pharmaceutical company to be imprisoned for conduct tied to the U.S. opioid crisis.¹

Who John Kapoor Is

Kapoor, born around 1943 in Amritsar, India, immigrated to the United States in the 1960s and earned a Ph.D. in medicinal chemistry from the State University of New York at Buffalo.²³⁴

Insys’s flagship product was Subsys, a sublingual fentanyl spray approved by the FDA for one narrow purpose: managing breakthrough pain in adult cancer patients who were already tolerant to around-the-clock opioid therapy. Fentanyl is a synthetic opioid roughly 50 times stronger than heroin, and Subsys grew more profitable at higher doses.⁵

What the Scheme Involved

Federal prosecutors alleged that from approximately May 2012 through December 2015, Kapoor ran a two-part conspiracy: paying doctors to write Subsys prescriptions in high volumes and at escalating doses, and then tricking insurers into covering those prescriptions.

Paying Doctors Through Sham Speaker Programs

Insys ran what it called “speaker programs,” ostensibly peer-to-peer educational events. In practice, most were shams. The company mined pharmacy data to identify doctors who already prescribed high volumes of rapid-onset opioids, or who might, and paid them “speaker’s fees” as rewards for prescribing Subsys. The expected return was explicit inside the company: at least a two-to-one ratio of prescription revenue to bribe payments. Doctors who didn’t write enough prescriptions saw their payments cut.⁶⁷

Additional inducements included lavish meals, entertainment, private jet trips, and jobs for prescribers’ relatives. One physician’s assistant at a New Hampshire pain clinic joined the speaker program in May 2013 and went on to write about 672 Subsys prescriptions, many of them medically unnecessary, in exchange for $44,000 in kickbacks.⁸

Sales representatives were pressured to push doctors toward “titration,” rapidly escalating patient doses. Higher doses meant higher prices and larger commissions. Although Subsys was approved only for opioid-tolerant cancer patients, the company aggressively marketed it for non-cancer pain and for patients who had never taken opioids.⁷

Deceiving Insurers

Because insurers rarely approved Subsys for non-cancer patients, Insys created the Insys Reimbursement Center. Employees there posed as staff from prescribing doctors’ offices and read from a deceptive script known internally as “the spiel,” making false statements about patient diagnoses and often claiming patients had cancer-related pain when they did not.⁶

The company’s culture surfaced at trial in an internal rap video from a 2015 national sales conference. Sales representatives rapped about dose escalation and volume while then-vice president of sales Alec Burlakoff climbed out of a giant Subsys-bottle costume at the end of the performance. Prosecutors introduced the video as an exhibit.⁷

The Trial and RICO Conviction

The case, United States v. Kapoor (No. 16-cr-10343), was tried in the U.S. District Court for the District of Massachusetts before Judge Allison D. Burroughs. A superseding indictment filed September 11, 2018 charged Kapoor and six other defendants with conspiracy to violate the Racketeer Influenced and Corrupt Organizations Act. Former CEO Michael Babich and Burlakoff pleaded guilty and cooperated. The remaining five went to a joint trial.⁹

Babich testified for the government over five days, walking through how the company picked bribery targets, tracked the return on speaker-fee payments, and adjusted payments based on prescribing volume. Internal spreadsheets calculating the profitability of bribes, prosecutors said, functioned as “smoking gun” evidence.¹⁰

On May 2, 2019, the jury convicted Kapoor and four co-defendants of RICO conspiracy.¹

The 66-Month Sentence

On January 23, 2020, Judge Burroughs sentenced Kapoor to 66 months in prison, three years of supervised release, and a $250,000 fine. She also ordered him to pay approximately $59.8 million in restitution and roughly $1.9 million in forfeiture.¹¹⁹

Judge Burroughs called the conduct “reprehensible and designed to financially incentivize healthcare practitioners to prescribe Subsys without regard for the best interests of their patients.” She added that the defendants “knew the power of Subsys and that addiction was a risk, but nonetheless tried to maximize the number of prescriptions written and the dosage prescribed.”¹²

Victims’ families and their attorneys called the sentence too lenient, pointing to fentanyl’s potency and to the 47,000 opioid-related deaths the CDC reported in 2017, more than a third of them linked to prescription medications.¹³

Appeals

Before sentencing, in November 2019, Judge Burroughs issued an 85-page ruling vacating some of the jury’s findings on Controlled Substances Act charges and honest-services fraud counts for four of the five trial defendants. She concluded that prosecutors had not proven the executives specifically intended for doctors to prescribe Subsys to patients who did not need it. “The Government could have easily proved bribery, but it elected not to charge bribes or kickbacks and now must live with that decision,” she wrote. The RICO conspiracy conviction and the mail and wire fraud counts stayed intact.¹⁴

Kapoor appealed to the U.S. Court of Appeals for the First Circuit, which in August 2021 upheld the convictions 3-0 and reinstated the jury findings Judge Burroughs had vacated, while sending the restitution calculations back for recalculation. On June 13, 2022, the U.S. Supreme Court declined to hear Kapoor’s petition, leaving the conviction and 66-month sentence in place.¹⁵¹⁶

Release From Prison

Kapoor was released from federal prison in 2023 after serving roughly two years of his sentence. A judge also ruled that he must repay $6 million in legal defense fees. As of September 2025, the U.S. Attorney’s Office in Boston reported collecting over $48 million in restitution from the convicted Insys executives.¹⁷¹⁸

Why the Case Was a First

Kapoor was the first founder or CEO of a pharmaceutical company to be convicted and imprisoned for conduct tied to the opioid epidemic. It was also the first time federal prosecutors deployed RICO, a statute typically used against organized crime, against pharmaceutical executives. U.S. Attorney Andrew Lelling said the prosecution was aimed at deterrence as much as punishment: “This case is not only about punishing these defendants. It is also about making the next pharmaceutical company think twice about its sales tactics and the basic corporate responsibility to not victimize the public.”¹¹

Ameet Sarpatwari of Harvard’s Program on Regulation, Therapeutics, and Law told NPR the conviction signaled that consequences for pharmaceutical misconduct could reach beyond corporate fines, long treated as a cost of doing business, to personal criminal liability and prison time.¹

The Insys story reached a broader audience through the 2023 Netflix film Pain Hustlers, directed by David Yates and based on the book by journalist Evan Hughes. Andy Garcia played a dramatized version of Kapoor, and Chris Evans portrayed a fictionalized Burlakoff. The film recreated scenes from the real case, including the rap video in the drug-bottle costume.¹⁹

1
NPR. Pharmaceutical Executive John Kapoor Sentenced to 66 Months in Prison in Opioid Case
2
The Hindu. Indian-American Billionaire Charged With Leading Pharmaceutical Fraud Scheme in US
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Forbes. John Kapoor
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The Print. Amritsar-Born Indian-American Executive Sentenced to 66 Months for Opioid Fraud
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NJ Consumer Affairs. AG Grewal Announces Multi-Million Dollar Settlement With Insys Therapeutics Founder
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FDA. Founder and Four Executives of Insys Therapeutics Convicted of Racketeering Conspiracy
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PBS Frontline. Opioid Drugmaker Insys: Bribing Doctors, Fentanyl Painkiller
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U.S. Department of Justice. Opioid Manufacturer Insys Therapeutics Agrees to Enter $225 Million Global Resolution
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U.S. Supreme Court. Kapoor and Lee Petition for Certiorari
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U.S. Department of Justice. Former CEO of Insys Therapeutics Sentenced in Racketeering Scheme
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U.S. Department of Justice. Founder and Former Chairman of the Board of Insys Therapeutics Sentenced to 66 Months in Prison
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Forbes. Insys Founder John Kapoor Sentenced to 66 Months in Fentanyl Bribery Case
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ABC News. Authorities Say Drugmaker Paid Off Doctors, Lied to Insurance Companies
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NPR. Federal Judge Overturns Part of Opioid Maker Conviction
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Reuters. US Supreme Court Rebuffs Opioid Maker Insys Founder’s Conviction Appeal
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Yahoo Finance. Opioid Maker Insys Founder, Others See Convictions Upheld
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Men’s Health. John Kapoor Now
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WWLP. Massachusetts Collects $48M Restitution for Opioid Scheme
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Time. Pain Hustlers True Story