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What Can We Take Away from Michigan Doctor’s Medicare Fraud Case?

Posted on August 4, 2015 by Kelly Wolford
doctor in handcuffs

Dr. Farid Fata was a highly respected and, by all appearances, successful doctor in Michigan who specialized in oncology, or the treatment of cancer patients. According to a recent Newsweek article, Fata had built a practice that spanned seven cities and served more than 16,000 patients.

The problem: His medical empire, according to federal prosecutors, was largely built on lying to patients, including intentionally misdiagnosing patients with cancer so he could profit from administering chemotherapy drugs to them.

In September 2014, Fata pled guilty to health care fraud, money laundering and conspiracy to pay and receive kickbacks. In early July, he was sentenced in the U.S. District Court for the Eastern District of Michigan to a prison term of 45 years.

While the depths of Fata’s alleged misconduct are certainly extreme, his story reflects three significant problems that the medical community must address:

  1. Too many potential conflicts of interest exist in modern medicine.

Newsweek reports that Fata allegedly prescribed more than “9,000 unnecessary injections and infusions to at least 553 patients over a six-year span” while his practice piled up “nearly $35 million in insurance billings,” including Medicare.

The Wall Street Journal states that roughly $25 million of those billings were directly attributable to Fata, making him the highest-paid oncologist in the country and the seventh-highest paid individual medical care provider overall.

Federal prosecutors claimed that Fata amassed his wealth by submitting insurance claims for services that were unnecessary, including prescribing chemotherapy to patients who did not have cancer but only needed observation, were already in remission or were terminally ill.

Unfortunately, as Newsweek points out, many doctors “bend their treatment decisions toward making the most money possible.” While this practice may not be fraudulent, as in Fata’s case, it raises concerns about conflicts of interest.

For example, a study reported in 2013 in the New England Journal of Medicine found that urologists who owned intensity-modulated radiation therapy (IMRT) services self-referred patients to this “expensive therapy” at a much higher rate than urologists who did not own IMRT services.

Patient health – not a doctor’s profits – should be the primary concern when a doctor makes a diagnosis and prescribes treatment. The potential for unethical or illegal conduct that harms patients exists where doctors can profit by making a particular diagnosis and treatment recommendation.

  1. More transparency is needed in investigations of medical wrongdoing.

Another larger problem can be seen in the case of Dr. Fata: A lack of transparency in the investigation of medical negligence and other misconduct.

In Fata’s case, a nurse reported concerns about the doctor’s practices to the Michigan Bureau of Health Professions in 2010. A year later, she was told that an investigation found no wrongdoing by the doctor. Roughly two years passed before Fata was arrested by the FBI, Newsweek reports.

How do we know the case was thoroughly investigated by the agency? We don’t. According to Newsweek, the state will not release its investigative file for public inspection due to privacy laws that are meant to protect medical professionals.

As a result of such privacy laws, important information is kept from the public and exposes them to the risk of harm. For instance, how many patients would have gone to a different doctor or at least sought a second opinion if they had known about the 2010 allegations against Fata?

Would those in charge of regulating Michigan’s medical professionals be facing well-deserved scrutiny if it was revealed that the investigation of Fata was lacking?

Here, in New York State, a 2014 report found that more needs to be done to inform patients about their doctor’s backgrounds. Currently, there is no requirement that New York patients be informed of a disciplinary actions against the medical professionals they turn to for care.

Even though patients can find that information by going to the Office of Professional Medical Conduct’s website or calling its hotline, the report found it to be “highly unlikely” that patients in our state know about disciplinary actions on their doctor’s record.

  1. Medical malpractice caps do not serve interests of justice.

Finally, it should be noted that Michigan, like many states in the U.S., places a cap on the non-economic damages that can be recovered in medical malpractice lawsuits.

Thus, despite enduring tremendous pain and suffering, patients harmed by Fata’s alleged misconduct will be fairly limited in the compensation they can potentially recover.

Fortunately, in New York State, there is no cap on medical malpractice damages. More states should follow suit. Justice is not served when victims are not fully and fairly compensated for the harm caused by negligent or reckless doctors.

If you would like to discuss suspected medical malpractice in a case that has harmed you or a loved one – specifically the delayed or missed diagnosis of cancer – please contact Powers & Santola, LLP. We would be glad to provide a free consultation about your case