A healthcare fraud scheme that deserves a life sentence

Farid Fata, a 50-year-old former Detroit oncologist, spent the first half of his life treating cancer patients. "Treating" may be a gross exaggeration of his approach to patient care considering he'll likely spend what is left of his life inside a jail cell.

On Friday, a U.S. District Judge sentenced Fata to 45 years for his role in a healthcare fraud scheme that involved unnecessary chemotherapy treatments to 553 different patients, netting him $34 million from Medicare. Those are just the rudimentary details--the ones listed in the Justice Department's announcement. The magnitude of Fata's true crimes lies at the feet of his victims and their families, many of whom poured out their grief in the courtroom during last week's sentencing trial.

They did not mince words. Laura Stedtfeld, the daughter of Piero Zanotti, who died in 2014 after being treated by Fata, demanded Fata look her in the eyes as she spoke to him, according to mlive.com. Zanotti was given chemotherapy treatments every other week for three years.

"Farid Fata: I hate you," she said." You are repulsive. You disgust me. You are a monster. You are evil."

Another patient, Maggie Dorsey, underwent chemotherapy treatments for multiple myelomoa, an illness that she never actually had.

"Even though I am not dead, I am a shadow of my former self," she said, explaining how the treatments took away her every basic function, even the ability to comb her daughter's hair.

Even the expert witnesses seemed dumbfounded with Fata's methods. One Harvard Medical School professor called his treatments "beyond aggressive," according to the Detroit Free Press. To another Harvard Medical School professor, David Steensma, the patient documents were mind-boggling.

"I've never seen anything like this," he said during his expert testimony, mlive.com reported in another article.

The number of unnecessary chemotherapy injections reached 2,770, according to Steensma. Another 3,556 were questionable. Essentially, patients under Fata's care were viewed as an ATM, a vessel full of cash that he could access not by entering a pin code, but by indiscriminately injecting chemotherapy drugs.

The victim testimonies are difficult to read. I imagine they were much harder to listen to when the emotional strain was more audible and the anger more visceral.

Fata's case and his victim's statements should be plastered on billboards across the country. This is the depraved and corrupt byproduct of healthcare fraud, a crime that is typically caculated in dollars and cents. In this case, patients paid with their livelihood.

Defense attorneys asked for 25 years so that Fata could be released from prison before he died. Prosecutors aggressively pushed for 175. It may have been more of a statement than a realistic expectation. 

Unfortunately, no amount of time would have been long enough to assuage the pain of those patients and their families. U.S. District Judge Paul Borman seemed to acknowledge that fact before handing down the 45-year sentence, calling Fata's case "horrific," and "unprecedented, I think, in terms of the amount of unnecessary medical treatments."

The case brings to mind that of Dipak Desai, the Las Vegas physician who was also sentenced last week to 71 months for orchestrating a fraud scheme that led to the largest hepatitis C outbreak in the country. The sentencing was more of a formality, considering Desai is already serving a life sentence for second-degree murder.

On paper, Fata's actions appear as bad, if not worse, than Desai's. Both prioritized volume over quality care in an effort to pull in as much money as possible. Fata was actively aware that his overtreatments would cause irreversible health effects.

Although the suffering of victims and their families deserve the spotlight in this case, in the aftermath of the sentencing, it's worth looking at how this kind of wanton fraud and abuse could have occurred. Christopher Friese, an oncology nurse and assistant professor and researcher at the University of Michigan School of Nursing offered two reasons in a guest column for the Free Press. First, chemotherapy clinics are often unregulated because they aren't affiliated with a hospital. But perhaps more importantly, physicians are reimbursed for each chemotherapy injection, incentivizing the Fatas of the world to maximize their profit with each push of the syringe.

Admittedly, Fata's indiscretions require a potent mixture of unrepentant greed and a sociopathic lack of compassion. But an opportunistic payment system allows those first two ingredients to manifest into a repulsive finished product.

We cannot control the greed that leads to this unconscionable level of care. But, as Friese points out, we can control a payment system that allows this type of fraud to occur. More importantly, we can see the inner workings of a horrific fraud scheme. Perhaps, the details of this case will offer a new perspective for investigators and auditors. For payers, it may offer a new perspective on how to approach reimbursement for cancer treatments.

Until then, this case should offer a stark reminder that healthcare fraud extends beyond inflated reimbursement and taxpayer dollars. It dismantles the lives of vulnerable and trusting patients and families.

One patient treated by Fata wrote before he died: "It is my dying wish that Dr. Fata be in prison for the rest of his life."

Fata will be 95 when his sentence ends. If it offers even a sliver of relief for the victims and their families, let's hope that wish comes true.  - Evan (@HealthPayer)