Interesting Links: June 15, 2015
Here are links to three interesting news articles (one recent + two older) about the same basic issue, namely the results of unrestricted profit-seeking in medicine under the guise of professionalism. Note that american-style frauds are usually a mix of self-delusion, image control and finding compliant underlings.
Fata’s Michigan Hematology and Oncology Inc. (MHO) was the state’s largest private cancer practice in 2013, with clinics in seven cities, its own pharmacy and diagnostic center, and 1,700 patients, virtually all of them assigned to Fata, the tireless physician. Those who needed proof of Fata’s dedication could look to the doctor’s work ethic — he often labored past midnight — or to the Swan for Life Foundation, a charity Fata established to help cancer patients and their families. Today, MHO is gone and Fata is behind bars, awaiting sentencing for at least $34 million in fraudulent Medicare billings and a kickback scheme with a hospice. The criminal counts only hint at the human suffering behind the financial damages and raise questions about how Fata’s schemes could go undetected so long, despite his many contacts, doctors, and huge roster of patients.
Maunglay was stunned by what the hospital chart suggested. A cancer-free patient being given chemotherapy wasn’t negligence; it was an atrocity. “It’s oh my God, if he can do this to a person who has nothing. …” he said one recent Saturday afternoon. “For me, one case like this was enough. How could a doctor do this? My father died of cancer. For most of us” — he waved his arms — “cancer is personal.” As a cancer specialist, he had a special understanding of the horror he was witnessing, its cruelty. Fata’s choice of myeloma, a cancer of the plasma cells in bone marrow, bespoke a certain shrewdness, because of the subjectivity of diagnosis. It was a clever niche for false doctoring. “You cannot fake lung cancer,” he says. “You cannot fake a tumor …” But with this disease, a malevolent doctor could plausibly use the treatment itself as a smokescreen to obscure future questions.
A Detroit-area cancer doctor accused of putting people through unnecessary treatments and then billing insurers for millions of dollars pleaded guilty to fraud Tuesday, admitting that he knew his patients often didn’t need chemotherapy. Dr Farid Fata pleaded guilty to 16 charges, including money laundering and conspiracy, without the benefit of a plea deal with prosecutors. US Attorney Barbara McQuade said she would not negotiate such a “shocking” case and will seek a sentence of life in prison. “We weren’t interested in bargaining anything away,” McQuade said. “His conduct was so egregious,” she told The Associated Press on the courthouse steps. “It wasn’t a matter of stealing money but torturing patients by lying to them about having cancer. … Chemotherapy is poison intended to kill cancer cells.”
His cancer clinic, Michigan Hematology Oncology, had seven offices and a related business that performed tests to look for cancer. The government says Fata submitted about $225m in claims to Medicare over six years, about half for chemotherapy and other cancer treatments. Medicare paid more than $91m, and private insurers were billed, too.
CTCA is not unique in turning away patients. A lot of doctors, hospitals and other healthcare providers in the United States decline to treat people who can’t pay, or have inadequate insurance, among other reasons. What sets CTCA apart is that rejecting certain patients and, even more, culling some of its patients from its survival data lets the company tout in ads and post on its website patient outcomes that look dramatically better than they would if the company treated all comers. These are the rosy survival numbers that attract people like the Hilborns.
“They market hope,” Gail Robison, a staff nurse at the Zion hospital from 2003 to 2007, said of CTCA. The marketing typically features CTCA’s state-of-the-art care and holistic approach. Ads note that featured patients might not be representative: “You should not expect to experience these results.” The ads also challenge viewers to “compare our treatment results to national averages.” Doing so, on the company’s website, shows that CTCA’s reported survival outcomes regularly beat those averages. Experts in medical data who reviewed CTCA’s claims for Reuters say those claims are suspect because of what they called deviations from best practices in statistics – in particular, comparing its carefully selected patients to those nationwide. “It makes their data look better than it is,” said Robert Strawderman, professor and chairman of biostatistics at the University of Rochester. “So the comparisons used to suggest that CTCA has better survival rates are pretty meaningless.”
CTCA also excludes from its survival calculations thousands of patients it does treat but who did not receive “treatment at CTCA for the duration of their illness.” “‘The duration of their illness’ is a very big and very red flag,” said MD Anderson’s Berry. CTCA’s patients will “tend to be healthier” than those in the general population from which SEER draws its data, he said, adding: “Ability and willingness to travel is an independent factor” associated with longer survival. No federal or state law requires hospitals to report their cancer outcomes, let alone mandates how to do the calculations. But many healthcare providers voluntarily err on the side of inclusion.
What do you think? Comments?