For weeks, one of the most widely emailed articles on Medscape, the physician-only medical news source, concerned Dr. Farid Fata, the 50-year-old cancer specialist who received a sentence of 45 years for fraud after administering inappropriate chemotherapy to hundreds of patients. Some of these patients had been previously cured of their cancer and yet he continued to prescribe “lifetime maintenance chemotherapy.” Others, it turned out, never had cancer at all.
Fata had built, in his own words, a cancer “empire,” a “kingdom,” including a pharmacy, a diagnostic lab, and a radiation treatment center. He also received kickbacks from hospices and home health agencies, ultimately raking in millions. In the end, his own employees were the whistleblowers, contacting the Feds, who did such a thorough investigation that even Fata’s expensive legal team couldn’t keep him out of jail.
Reading the testimonies of Fata’s victims and their families is truly horrifying. They recount not only the grim physical symptoms of cancer chemotherapy, but the emotional burden of living with a diagnosis that they later learned had been an utter lie. The daughter of one victim said to Fata “I hate you. You are a monster. You are evil. You poisoned him. You tortured and murdered my dad.”
Almost as dramatic are the 247 physician comments that follow the Medscape article, with more being added daily. The general trend among the physician commenters is a hand-wringing “now patients won’t trust us” whimper. A second group graphically describes the punishment they would have administered had they been Fata’s judge (death sentence is popular, daily chemo another).
Just a few commenters remark on an uncomfortable yet germane issue: the likely financial collusion between Fata and anyone (physicians or hospitals) who benefitted from his brutal kingdom’s largesse. This includes deliberate or neglectful failures of a hospital’s review board, the checks-and-balances system designed to prevent such malfeasance. One interesting group of physician-commenters writes of their personal experience with specialists—including oncologists, but any procedure-driven specialty can be guilty–who they strongly suspect of utilizing services unnecessarily and yet they don’t have a strong case to make against them.
(When you’re a primary care physician hospitalizing two or three patients a month, the hospital administrator is not at all interested in your criticisms of, for example, a physician whose well-populated spine surgery hospital unit is keeping the hospital afloat.)
The euphemism is “overutilization,” which simply means doctors ordering tests, procedures, surgeries, or equipment that really are not needed except to circle back to some financial benefit for the ordering physician. In one recent case, an orthopedic surgeon had been encouraged to buy stock in a company that manufactured joint replacements. By performing a lot of procedures using the company’s equipment (some surgeries needed, most not), his stock appreciated wildly in value. The unnecessary surgical procedures are, of course, morally wrong. Billing an insurance company to pay for this surgery is called overutilization.
The Nazi Doctors
Both Fata’s crime and the way the survivors expressed their suffering reminded me of Robert Jay Lifton’s 1988 The Nazi Doctors, a meticulously researched and utterly horrifying book that tells how members of the medical profession during the Third Reich not only participated in bizarre experiments on concentration camp detainees (including children and the disabled), but also were instrumental in every step of the Holocaust extermination process, from transport to gas chamber and ultimately disposal of remains.
For his book, Lifton interviewed some of the participating physicians. Most believed their work was noble and had few regrets about being part of what they considered a cleansing and healing of their race. Testimonies from the handful of surviving victims, heard at the famous postwar Nuremberg Trials, sound frighteningly like what Detroit jurors heard last month during Fata’s trial.
Like the Nazi doctors interviewed by Lifton, I suspect Fata didn’t see himself as a monster. He may have had some misgivings, but I doubt he thought he was doing anything seriously wrong. He probably envisioned that final elusive cancer cell hidden somewhere inside every patient and, like the Nazi doctors scrubbing Germany to complete Judenfrei Aryanization, justified the chemotherapy with some cliché like “Let’s work together and mop up every last cancer cell.”
By the way, I didn’t pull that line out of the blue. Patients have told me stories of how, in the wake of their surgeon pronouncing their cancer surgery successful, in strolls the oncologist with that cancer “mop up, no-cell-left-behind” routine.
Overutilization
The awful truth is that you have to wonder exactly how much overutilization (oh, that word again!) is actually going on in the $3.8 trillion being spent on US healthcare every year. Believe me, a lot more than you want to know. Creeping into the system is a shift from the Hippocratic “First, do no harm” to a pervasive and insidious “Where’s my share?”
- In June, a Nevada spine center and its surgeons were indicted for a complex scheme involving counterfeit joint replacements and unnecessary surgery.
- In May, a Michigan spine surgeon admitted to $11 million in fraud for unnecessary surgeries. I once remarked to a non-spine orthopedic physician about the increased number of spine procedures being performed and asked about the criteria for surgery. “These days?” he snorted. “Two criteria. Does the patient have insurance? Does the patient have a back?”
- Here in Chicago, executives at Sacred Heart Hospital are about to be sentenced for a complex kickback scheme that resulted in hundreds of unnecessary hospitalizations and surgical procedures.
In my own (many) years of primary care medicine, I’ve certainly heard about or seen myself countless instances of inappropriate treatments, both medical and surgical. Most of what you’re gut tells you is an unnecessary procedure is extremely difficult to actually prove. The best a doctor like me can do is simply avoid that particular specialist like the plague.
When a doctor becomes a veritable loose cannon of inappropriate care, various hospital committees, physician review boards, and even the federal government can step in, but the cost to investigate a case and finally prove damages or fraud must be enormous, what with chart review, interviewing victims and other physicians, and even taking steps like phone/internet tracking and wearing recording wires. The Illinois Department of Financial and Professional Regulation, which oversees anyone with a license (from acupuncturists to veterinarians), is, like everything in Illinois, understaffed and underfunded.
Over the years, I’ve followed investigations into cardiologists, ophthalmologists, dermatologists, urologists, and gastroenterologists–in fact, members of virtually every procedure-driven specialty–who had been accused of inappropriate overutilization. Procedures included unnecessary coronary angiograms, cataract extractions, colonoscopies, and removal of prostate cancers.
Generally speaking, some doctors involved in fraud are fined, some are required to return money to Medicare or to insurance companies, a handful are jailed. Some, if the pressure is too intense, will, like child-abusing priests transferred from parish to parish, simply set up shop elsewhere. And because every rogue physician is a cash cow for a lot of interested people, hospital executives can be extremely reluctant to initiate any investigation when issues of fraud or malfeasance are raised.
So we’ve got a health care system in which a physician can financially become as rich as Croesus if he follows the guidelines and moral code described in The Nazi Doctors. The questions become: How did we get here and what can we do about it?
That’s for next week.
Be well,
David Edelberg, MD
Anytime there is money to be had, there is someone(s) out there to get a piece. MI has an interesting law regarding car accidents – if someone claims they were hit, they don’t need even a plate number to file a claim into a state group that gets a pool of money from the auto insurance companies in that state. While over prescribing physical therapy is usually not harmful to the patient [part of that scam/game], that is one way that system gets milked. For years, plaintiff’s attys would hire drs to do mass screens of persons in unions with likely asbestos exposure so they could file lawsuits for non-cancer asbestos related illnesses [of course if it turns to cancer, a new lawsuit can be filed]. Regarding the cancer dr, well, some cancers – like my Mom’s small cell stage 3b lung cancer – require treatment to be started pretty immediate to make it to a year past diagnosis (maybe), and unlike persons in Chicago, not everyone is close to a lot of medical centers to go back and forth for treatment 2-5 days a week. And some patients, sadly, view their drs as an all-knowing God – and I’ve met a couple of doctors that believe that of him/herself.
Wendy
I also had read the news articles covering Dr. Fata, and I’m rather surprised that he was able to pull it off to the extent that he did. Cancer patients are encouraged at all treatment stages of their disease to get second and even third opinions, fees for which are typically covered by their insurance company. Assuming Dr. Fata’s treatment plans were inappropriate for most, additional consults would have highlighted this, allowing the patient to make better choices. It’s difficult to be a cancer patient and not hear from cancer associations literature, government agencies, other (non-oncologist) physicians of the patient, and friends and family why second opinions are so important. The ~ 50 National Cancer Institute centers are very appropriate places to go for this, and are highly accessible and well-publicized, but any regional cancer center that is not affiliated with the patient’s own medical facility could be used. Cancer is rarely a condition that requires immediate emergency treatment, and any decent oncologist or surgeon does not at all mind their patients consulting with others to verify the diagnosis and recommendations for a treatment plan. Dr. Fata’s case is a good example why patient education is so very important, since obviously the patient needs to be aware why a second opinion may be crucial to the outcome of their disease – and to their overall long-term health.
Margo
Hi Curie
I got the $3.8 trillion from Forbes. Here’s the link
https://www.forbes.com/sites/danmunro/2014/02/02/annual-u-s-healthcare-spending-hits-3-8-trillion/
Dr E
I hope this awakens people to realize that doctors are people, some good, some bad, many very BAD !
Never allow any one doctor to control your healthcare and life. Get second opinions, demand copies of all test results and have them read by other medical professionals. Do your own research and if the doctor doesn’t like you asking questions and reading research then time to change doctors !
This sociopath will be in one of the exclusive elite prisons, not much of a sentence for what he has done to people, their families and communities.
What I have observed over the last 40 + years is people going into medicine only for MONEY, it is a variation of WALL STREET now ! Medicare for all is the way to go and what was attempted but the masses could not accept that, Medicare is proven and with more funding for operations it will be an excellent plan for people in this country. The CORRUPT Insurance Industry will never allow that to happen !
Cate
I work in a medical school and know that by and large most of the students come into medicine for altruistic reasons. However, by the time they leave residency they are burned out, cynical, have huge debt and under the pressure to generate RVU’s-relative value units. RVU’s are comparable to piece work in a factory. It’s so sad to watch the changes that occur in some of Americas finest and brightest. And of course, let’s not forget big pharmas hand in all this.
It’s a very troubling and sad situation. So many people have lost their integrity in pursuit of the great American dream. Not what our founding fathers intended I’m sure! We just lost a dear friend to cancer and there are so many “cures” out their but so little data to support and yet when people are desperate they will pay as much as possible and sadly often broke and dead. It is so hard to know who to trust anymore! Complimentary health care jabbing at Allopathic medicine and vice versa. What is the truth?!!!
I don’t know what the answer is because I have spoken with our medical learners from other countries that are single payer and they are frustrated as well. One MD takes medicine overseas because his family can’t get the “quality” care that is possible.
Bottom line: we all have to take great responsibility for our health, do our due diligence and not be afraid of the long white coats and ask as many questions as possible. They are trained to be great sales people but they have agendas, needs, dreams and desires as well.
In closing, trust must be earned not blindly given because they have on the long white coat no matter whether is was allopathic or complimentary medicine.
Cherie
In health care the numbers get so big a few hundred billion here or there is essentially rounding error.
Having said that, health care spending this year is estimated to be under $3.2 trillion, not $3.8 trillion as you say (per CMS projections published last September).
Here’s one way to catch some of this fraud earlier: A single payer non-profit national health program. A single payment database makes it possible to find “outliers” – doctors who are billing for more treatments than their peers – and investigate. Right now doctors bill hundreds of different plans, which not only adds administrative expense, but makes it hard to detect fraud.
Curie
How does Single Payer…..or Medicare for All….fit into all this?
The healthcare system in this country is a “for profit” model, controlled by health insurance companies. Health Insurance companies wrote the ACA, and have, since its implementation, added millions of people to their monthly premium bottom line. Make no mistake, the ACA is good for the heath insurance business…..but it is better than nothing.
I could make this a long dissertation on why the rest of the industrialized world provides healthcare as a human right for their citizens, and spends less than half what is spent here in the USA, but it is best people research this on their own, for then perhaps the facts discovered would be shared with friends and family, and perhaps some change would be forthcoming if more people became involved in the effort to change what is wrong with how the USA provides healthcare to those who can afford to pay…..the rest of us are on our own…..we can have all the healthcare we can afford.
There is someone who writes about our healthcare system and how it works….his name is Wendell Potter, and he is the Senior Analyst at the Center for Public Integrity. He wrote an article this past June titled: For Profit Hospitals Mark Up Prices by More than 1,000 Percent…..and he explains the Chargemasters, billing system used by hospitals to make their profits…..even non-profits make profits.
Until healthcare is no longer a profit driven business things will not change. Ask any person 65 and older if they would give up their Medicare….the answer will be “no way”. So we need a Single Payer system….not based on profits….which is a Medicare for All system….use it, improve it, and make health care available for all, no matter one’s ability to “pay”.
Kathryn Donahue
One more example of how our for profit health care system is profitable for many in the system, and bad, very bad, for patients, for the receivers of health care.
We need to get money out of politics and profit out of health care. It can be done, and only if we all wake up and act.
I’m so thankful for Whole Health Chicago.
John
Nothing doctors do today surprises me. 20 years with a chronic illness and I must say I have lost all respect for the profession, for doctors, for the system and for the sociopaths who seem drawn to the “healthcare” scheme today.
This is particularly alarming but it is very common today to experience total disregard for the person, the human being.
I try to avoid the system and the corrupt doctors as much as possible. This industry is a menace to society.
I would choose to die before going to the ER today. Doctors LIE and show total disregard for people. It is a different system today, one I abhor. Thank you for shedding light on this.
Cate
Hi,
There is an alternative health care center that started up in my area that is going out of business because they decided to go for the health spa crowd. I was so glad to have found them because they did uncover some of my issues that traditional doctors werent looking for. In the beginning, they operated out of an old building that had hardly any parking.. but that didn’t matter because they were providing a much meeded service in an area wth hundreds of thousands of doctors who pretty much all thoughtvthe same.
But they had a vision of much more than providing great, alternative health care. Two years ago, they built a state-of-the-art facility, with a waterfall in the entry way, yoga rooms, spacious waiting areas with free organic teas. One certainly felt special there at the health spa.
6 months ago, my insurance abruptly stopped paying for the alternative allergy treatments this center provided. Then the center started to tack on little fees here and there without warning.
I began to suspect they were in financial trouble when they diagnosed me with heavy metal toxicity through IV provocation and recommended thousands of $$ of IV chelation therapy, not covered by insurance. They also wanted to give me conventional allergy shots once a week for a year. I questioned if my insurance company would pay for this, since that’s not the conventional way of of doing it, and I was told that they did it that way because it’s gentler on the patient. That didn’t jive with the IV chchelation.
Then they instituted a membership program, where if you wanted to continue to see you primary care doctor, you had toj oin their service. I paid $90 for three months because i felt I had no choice, but finally threw in the towel when my doctor wanted me to do a couple of very expensive tests through Drs Data, tests that I didn’t think were necessary. They also charged me for the kit, something they never did before.
There were other weird things–their membership department seemed like a separate, fonancial entity–an LLC. At first, I opted to pay for the year membership because it was cheaper than the month to month plan. I had to sign several legal forms and after a couple days, I decided to go to the monthly option, but it took a month to get my money back, even though theybegan to charge the monthly fee on top of that.
That was 6 months ago. Now they are closing. Everyone who paid a year membership is out of luck. This outfit started out providing good, alternative healthcare, but got caught up in the money making medical model because they got in trouble building that state-of-the-art medical spa buloding. It’s very tragic because a lot of very good doctors got caught up in this scheme.
I don’t know how this could have been ptevented. Maybe if they would’ve communicated more with their patients, they would’ve found out what we wanted or not and never built such a money pit. Maybe if we had a single payer system, there wouldn’t be this entrepreneurial drive to capitalize on people’s suffering.
That’s the core problem of market place medicine. The patient loses trust when they realize that their doctors are more concerned with making money than providing good health care. When insurance companies are the middle man, patients don’t feel the brunt of this and act accordingly. However, when the patient is paying directly, they begin to question what’s being done with their money and act accordingly. I’m sure that a lot of patients did what I did–walked away from a system that had become more focused on money than people.
I don’t know what the answer is to fix our health care problem. The convential health systems have their routines that miss a lot of early or alternative diagnosis. Not all stomach problems can be cured with proton pump inhibitors, nor are all patients that don’t get well head cases. Is their an alternative system that could work? Could there be ways of using the Internet to include and empower patirnts in their own welness? Is this already happening? How does single payer fit into all this?
What do you think?
Teresa Strong