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The Farid Fata Medicare Fraud Case and Misplaced Incentives in Oncology Care.

On July 10, 2015, in a health care fraud case that US Attorney Barbara McQuade called “the most egregious” her office had ever seen, Michigan oncologist Farid Fata, MD, was sentenced to 45 years in federal prison by Judge Paul Borman of the US District Court for the District of Eastern Michigan and ordered to undergo treatment for substance abuse. In addition, the court found that Fata’s crimes resulted in at least $17.6 million of payments for fraudulently ordered treatments, and Fata agreed to forfeit millions of dollars in assets, much of which will go to pay restitution to former patients or their families. Fata pled guilty in September 2014 to 16 federal charges: 13 counts of health care fraud, two counts of money laundering, and one count of conspiring to pay and receive kickbacks and cash payments for referring patients to a particular hospice and home health care company. The basis for these fraud charges was Fata’s chemotherapy treatment of patients who did not have cancer or did not require treatment as well as excessive use of expensive supportive care medications, which included hematopoietic growth factors, intravenous iron salts, and intravenous gamma globulin (IVIG). In addition to these charges, the court found at sentencing that Fata also mistreated patients with inappropriate parenteral vitamins, octreotide, and potent antiemetics. The charges against Fata included patients covered underMedicare, Blue Cross Blue Shield, Health Alliance Plan, and Aetna. I was one of two expert witnesses who sorted through tens of thousands of pages of pretrial evidence and testified in federal court in July 2015 on behalf of the government in United States of America v Farid Fata, MD. The Fata case was my first encounter with the justice system. I had always envisioned that if I were ever to end up in a courtroom electively, that it would be in support of a colleague, such as to defend another physician who had made a difficult judgment call in a complex case that resulted in a poor outcome. The Fata case changed that. When I was first approached by the government in September 2013 to review cases related to a developing oncology Medicare fraud case in Michigan, I was somewhat skeptical. Medicare rules for clinical coding and billing are notoriously byzantine and arbitrary, and I imagined an aggressive federal prosecutor trying to send a busy oncologist up the river for billing a few E5 evaluation and management codes when he had only checked off enough review of systems boxes to justify an E4. But when I reviewed the first few charts of Fata’s former patients, it became clear that what occurred in his offices in suburban Detroit, Michigan, was far more troubling than simple overcoding. Fata had seven offices in Eastern Michigan, and he owned an in-house chemotherapy pharmacy, a radiation oncology practice, and a diagnostic testing company with radiographic equipment that included a positron emission tomography scanner. He