There are few felons who can top the pain caused by so many victims as Dr. Farid Fata, who is facing a demand by prosecutors for a 175-year sentence for sending hundreds of healthy patients into unnecessary cancer treatments.
Some 553 patients were given the unnecessary cancer treatments to 553 patients before Fata was arrested in 2013. He was accused of $35 million in Medicare fraud. He pleaded guilty in the fall to fraud, money laundering and conspiracy charges.
Absent the plea, some of the cases might have produced some challenging evidentiary burdens. Some of the patients had cancer but were over treated while some received the wrong treatment for their type of cancer. Those could be defended as malpractice but not fraud. However, there appeared to be enough evidence of knowing fraud to force Fata to throw in the towel on trial.
The trial itself would have allowed patients to recount how they suffered organ damage as a result of unnecessary treatment. Moreover, these victims had to tell their loved ones that they had cancer and prepare their families for their possible deaths. One man lost a testicle and came close to kidney failure due to the unnecessary treatment.
What most concerns me are accounts of people complaining as early as 2010 with no action taken to shutdown this doctor.
In the meantime, the defense counsel is seeking a limit on victim’s statements for sentencing — a difficult proposition for a court in cutting off the right of victims to speak about their loss and pain.
Another interesting aspect of this case is how to handle the civil liability. He presumably had insurance coverage but the sheer number of cases presents a daunting problem for courts. This would seem a good case for special management like a mass tort situation where a court can administer the claims while reducing the litigation costs. Since liability is obvious, it would be unfair to see these victims paying either full contingency fees or high hourly rates for victims of 30 percent or more. Ideally, these claims can be administered through a single court. However, the insurance company may wish to contest some cases as properly diagnosed. That could lead to litigation in those marginal cases.
http://www.fraud-magazine.com/article.aspx?id=4294976280
10 popular health care provider fraud schemes.
Billing for services not rendered.
Billing for a non-covered service as a covered service.
Misrepresenting dates of service.
Misrepresenting locations of service.
Misrepresenting provider of service.
Waiving of deductibles and/or co-payments.
Incorrect reporting of diagnoses or procedures (includes unbundling).
Overutilization of services.
Corruption (kickbacks and bribery).
False or unnecessary issuance of prescription drugs.
Patrick McDonald runs a good site on medical world problems:
http://medicalmiscreants.com/
I used to have a page from him bookmarked that showed stats on how many people died from health care providers each year. Must have gotten lost in computer shuffles, but he still posts for the world to see.
“There is no motive for a salaried doctor to make false diagnoses.”
The good doctor is again correct.
Salaried people never ever loaf, steal, lie or commit fraud.
Although making a false diagnosis might make your caseload seem harder than it actually is, or make it seem you are spending more time with patients than you actually are, or be used as part of a bogus research project for money on the side, or manipulate certain patients, or give you status as a local “expert” in a disease like “Chronic Lyme disease”, or….
Of course, that would never ever happen.
Salaries prevent fraud. Everyone knows that.
To CCPGI
Salaries prevent fraud.
It would be nice if that was true but it removes one parameter from the equation. You have to decide if you want good medicine or not. It doesn’t appear to be that good?
Or is it?
If it is so good why isn’t everyone happy?
He should be sentenced to 175 years of his own medicine.
ninianpeckitt
“But in this case it isn’t government money”
“oncologist/hematologist Dr. Farid Fata of Oakland County, was not only accused of bilking Medicare of tens of millions of dollars…”
You are correct.
Medicare is not government money.
It is free money for all that falls from the sky, but doled out by the Holy State.
To CCPGI
So it’s YOUR money then….
The issue is that it is still used to pay for item of service. That’s the Achilles Heel of the system and why can never work.
Chief Consort PGI-
What motive is there for salaried health care providers to make false diagnoses?
Salaried Service
There is no motive for a salaried doctor to make false diagnoses. But in a fee/case system it is possible for hospital managers and hospital board who control the billing to commit fraud. We have CEOs in the UK who have been jailed for this. If you can remove the transfer money from the equation in as much of a practical way as possible this should address the bulk of this type of problem.
But that is not how America works
And that could be a big problem if this is to be addressed
What Ninian Peckitt wrote, the “anarchy” comment excepted.
Unfortunately, this sort of thing can be expected in backward capitalist patriarchal health systems.
It never happens in utopian single payer medical systems.
Never.
Now that the U.S. Is ridding itself of the cancer of highly regulated insurance to a Medicare-for-all model, this sort of thing can be expected to disappear.
Paul, Attorneys police themselves. And, there is the rub!
Post Script
I have never understood the thinking behind a 175 year sentence. Why is such a sentence not “Life” without parole for example. I’m sure there must be a reason, but I don’t know of anyone even in the American Healthcare System that has lived to 175 years. I’m sure it must be to express public outrage etc but it is a bit odd….
np – if you would get an American Civics book you would learn why the 175 years sentence and not life w/o parole.
Paul Schulte: 175 year sentence
I’m sure I would learn a lot
But a 175 year sentence is still bonkers.
WHEREVER there is govt. money there is fraud. You see, govt. bureaucrats do not look upon the money they dole out as theirs, IT’S YOURS, and for these bureaucrats, it’s free money. Fraud is rampant in ALL govt. programs, on a macro and micro level. Federal, state and local governments all have disgusting amounts of fraud. It is one of the reasons I am a libertarian. Private companies hire me to detect fraud. I’m working on some right now. I have also done work on govt. fraud. Private companies are serious about stopping fraud, since it’s THEIR money. The govt., well they don’t give a rat’s ass. From my experience, government bureaucrats often hired me to investigate fraud when they had a personal ax to grind w/ the recipient, or just didn’t like them. Totally unprofessional.
But in this case it isn’t government money
Goodness Me…. This is dreadful for a doctor to behave in this way.
The main thing to address any personal injury of the patients and to ensure appropriate compensation.
My understanding of American thinking is that it is based on item for service. You go to a dealer and you buy a car. You go to the store and buy groceries and you go to a hospital and buy health. It is the American way of thinking. But it can have its problems.
I now have to throw a bone in the bear pit…….
This sort of fraud can only happen in a pay per item system of healthcare.
Prior to 1980 in the UK we had a socialised medicine system that was not related to pay per item nor to private health insurance. Doctors were salaried, but could engage in a pay per item service in Private Practice. But the NHS was not funded in this way. And it worked. Moreover it worked very well indeed. Patients trusted doctors the standard of care was high and staff were motivated by service rather than salary.
After 1980 a managed market system was introduced loosely based on the US System of fee per item and the result has been chaos, abuse, fraud and corruption.
So I would like to ask you to think about the following points:
– Are you happy with your system of care ?
– Are you happy with insurance cover (are your diseases covered) ?
– Are you happy with cost of insurance ?
– Are you happy with the probity of the insurance industry in healthcare ?
– Do health insurance companies have too much power?
– Are you happy with standards of care ?
– Does care represent value for money?
– Do you trust your doctor?
– Do you think over investigation of patients for profit is a problem?
– Does your doctor operate outside his/her experience drifting into other specialties for profit?
– How can your current system be improved to address fraud?
– Would a different system of healthcare improve probity?
– Do you want a different system introduced and if not why not?
This case could be the tip of the iceberg.
What I don’t understand is how an insurer can fund a cancer case without proof of diagnosis by biopsy.
Doesn’t the insurance company have a duty of care to its policy holder?
I am arguing that this case illustrates much of what is wrong about the American Healthcare System and this sort of abuse will always continue under the current system you have adopted. It has demonstrated the Freedom to make a mistake.
Freedom minus Responsibility and Accountability = Anarchy.
Insanity is doing the same thing again and again and expecting different results
Albert Einstein
You have to decide when enough is enough……
NP Cancer care failure in UK
http://www.dailymail.co.uk/news/article-3149544/Betrayed-NHS-Two-lives-two-avoidable-tragedies-two-shocking-indictments-cancer-care-UK.html?ITO=1490&ns_mchannel=rss&ns_campaign=1490
Paul Shulte
Our system in the NHS is dreadful. But it is dreadful because of the reforms introduced in the 1980s which mirrored the American System.
Costs sky rocketed and our NHS has collapsed – not because of socialised medicine. That is dead and buried. We now have our own endemic fraud and those if us who speak out are targeted by the admission of government.
So the message is this system does not work and more importantly it can’t be made to work.
A way has to be found “to take money out of medicine”.
If you can find a way to do this, your healthcare will be transformed.
If you can’t do it your system will collapse
This guy is truly sick.
“What most concerns me are accounts of people complaining as early as 2010 with no action taken to shutdown this doctor.”
JT, Please, your blog is full of incidents of lawyers and judges that have done grievous deeds. Isn’t there a mechanism to discipline lawyers? And how often do truly despicable people remain lawyers or judges? The cartel of a group of doctors is no different than the cabal of lawyers in protecting their own.
In many cases, people have no symptoms when a doctor finds “cancer”. Second and third completely independent opinions should be obtained before anyone is given potentially harmful treatments. Electronic patient records available to any doctor would make independent second opinions next to worthless. While they can reduce over-use and abuse of health care, as well as save lives in emergency situations, electronic patient records should not be available universally to health care providers.
As a cancer patient, I wish his patients the best. They should find the roughest prison with a general population and put him there.
A special master might be set up for the patients for setting claims. There are probably a couple of insurance companies, plus his own money to go through.
Maybe he will try to claim this is “defensive medicine” and blame it on frivolous lawsuits. Many would believe him.
On the first issue, the guy should do a Bernie Madoff.
On the second, a board of inquiry should be set up by either a government third party agency or an independent agency to ascertain the structure(s) of the civil lawsuits. The cases, if any, that were valid, i.e. the patient was properly diagnosed, received the proper treatment, and with the typical results, should not be included in any lawsuits. This would close the door to another and rampant sort of fraud.
For those who have suffered, this suffering could easily be determined by the results: time, physical damage, etc. With hundreds of potential lawsuits, contingency fees which average around 40% could be substantially eliminated. This provides an incentive for both the plaintiff as well as the defendant. A million dollar decision would see $600k go to the injured party. With a brokered deal the injured party could be offered $800k and the insurance company save $200k. Multiply this by a few hundred cases and perhaps substantially larger amounts and the advantages to both sides become apparent.
The only problem is that the legal profession would cite some Constitutional right that not only provides for an individual to have free access to legal representation but somehow would demand that they all be done one by one, to the max, an the expense of all who pay into the insurance program. This is not an example of ambulance chasing but one where the ambulance stopped by the law office on the way to the hospital.
This is another argument for government involvement in the health care industry. In Canada, for example, when a doctor is found negligent the injured party typically receives as large if not a larger compensation than in the US, however, in Canada there are far fewer petty lawsuits.
The involvement of the government in instances where many people are injured by the same cause and a quagmire of legal nonsense and expense has been avoided can be seen with the BP oil spill in the Gulf. Obama stepped in immediately and demanded and received $20billion from BP. This saved billions in legal fees that now could go directly to the injured parties and clean up. BP can not escape the US government but it can manipulate individuals until well after they are dead and gone. It is estimated that BP will eventually pay out over $50billion for their mistake. Left to their own devices BP would have probably targeted its legal expenses only.
How about attempted murder charges? He should go away for a very long time. He was willing to pu the lives of these people at risk so that he could make money. His willful indifference was generalized willful blindness which is bad enough but he looked these people in the eye and then knowingly put them at risk.. I say throw away the key!
As to the civil liability issues, it would be nice to think that a settlement vehicle would truly compensate the victims but the new settlement vehicle industry is really a way of protecting the corproate entity that is on the hook of or the damages. Victims need lawyers to protect their rights and their claims but fees are so limited that victims find it hard to get individual representation. Any such vehicle must be structured to protect victims not the insurance companies and give victims the resources to have lawyers who will protect them.
Individual Medicare recipients.
Medicare fraud from providers much more common than Medicare fraud from individuals. This is the sort of case my daughter’s friend who works in DC in the Medicare Fraud department does. Good job!