Physician Gave Chemo to Patients Without Cancer, Feds Say

Robert Lowes

 
Hematologist-oncologist Farid Fata, MD, in suburban Detroit, Michigan, was arrested August 6 and charged with Medicare fraud in a federal case that stands out from dozens of others recently brought against healthcare providers.

For one thing, the dollar amount of alleged fraud — $35 million — is higher than most for individual providers charged by the government. The potential physical harm to patients described by prosecutors also is far more substantial. In a criminal complaint filed in a federal district court in Detroit, prosecutors said that the 48-year-old Dr. Fata ordered toxic chemotherapy for patients who did not have cancer or whose cancer was in remission. Doing this “is simply poisoning the patient,” prosecutors said in a later court filing.

And something else happened in Dr. Fata’s case that is unusual: Rather than keeping their heads down, some employees at Dr. Fata’s high-profile practice challenged his actions before he was arrested, according to the government.
One employed oncologist, for example, told agents from the FBI and the Department of Health and Human Services that he discovered that Dr. Fata had ordered chemotherapy for a patient whose cancer was in remission. The oncologist said he advised the patient to get a second opinion and not return to Dr. Fata’s practice.
This oncologist and other employees also reported that Dr. Fata ordered intravenous immunoglobulin (IVIG) for patients whose antibody levels did not warrant the therapy. One nurse practitioner (NP) told federal agents that she pulled the charts for 40 patients scheduled for IVIG therapy and saw that 38 had neither low antibody levels nor a recurrent infection, which is another indication for the treatment. The NP consulted 2 other employees about the issue, and the 3 of them canceled the IVIG therapy for the 38 patients.
Dr. Fata’s employees had internally challenged other practices they considered unethical, such as fabricating cancer diagnoses in patient records to justify insurance claims for chemotherapy and positron emission tomography (PET) scans, according to interviews conducted by federal agents. Some employees quit over these issues. The employed oncologist, who had considered quitting, described working with Dr. Fata as “living with this hell.”
Dr. Fata has not yet had his day in court to refute these charges. “He vehemently denies all the allegations,” said Christopher Andreoff, the physician’s attorney, in an interview with Medscape Medical News.
Andreoff faulted federal prosecutors for failing to review patient files “to determine the propriety of diagnoses and subsequent treatment.” He also said that the federal charges do not identify the current and former employees of Dr. Fata cited in the criminal complaint. They may be “disgruntled,” he said.
“People shouldn’t race to make a judgment,” said Andreoff. “There’s still the presumption of innocence.”
On Thursday, US Magistrate Judge David Grand ruled that Dr. Fata could get out of jail once he posted a $170,000 bond. Prosecutors appealed the judge’s decision but lost, according to newspaper accounts of yesterday’s court proceedings. Grand said that Dr. Fata must not practice medicine or bill anyone for the time being as conditions of his release.
Federal prosecutors wanted Dr. Fata behind bars while he awaits trial. They argued in a court filing that he poses a flight risk and possesses the means to return to his native Lebanon because the taxable estate for him and his wife exceeds $40 million. Although the government has begun to seize some of his assets, others are at Dr. Fata’s disposal, prosecutors said. Andreoff countered that his client is a naturalized American citizen who has traveled only once to Lebanon since 2001.
Prosecutors also emphasized the severity of the charges against Dr. Fata in their arguments to keep him locked up. They said that if convicted, Dr. Fata faces substantial time in prison, especially if unwarranted chemotherapy has injured or killed any patients. They noted that some of his patients already have complained to a local newspaper that they suffered mistreatment. The Oakland Press quoted the father of one deceased patient as saying that his son had been “tortured” with needless chemotherapy.
An Otherwise Shiny Career
Regardless of whether Dr. Fata is found innocent or guilty, his arrest on August 6 stands in jolting juxtaposition to an otherwise shiny career.
Dr. Fata completed a hematology-oncology fellowship at Memorial Sloan-Kettering Cancer Center in New York City. In 2005, he founded Michigan Hematology Oncology (MHO), which now has 60 employees and 7 locations throughout suburban Detroit. According to the MHO Web site, Dr. Fata’s research has been published in peer-reviewed journals such as Cancer, the Journal of Clinical Oncology, and the  Annals of Internal Medicine. A search of medical literature through PubMED unearthed 20 articles in which Dr. Fata is a coauthor and sometimes the lead author. The MHO Web site also states that Dr. Fata often lectures at hospitals in southeast Michigan and functions as principal investigator on cancer protocols funded by the National Institutes of Health.
Dr. Fata also has made a name for himself as the founder of Swan for Life, a nonprofit organization that provides “support, education and resources to cancer patients and their families,” according to the group’s Web site. Swan for Life programs range from support groups and educational workshops for patients to fee-based medical services such as acupuncture and clinical massage. The nonprofit has raised money through fashion shows, a gala ball, and an annual 5k run, the most recent one on August 4.
Dr. Fata was listed as president of the foundation, and his wife Samar Fata as treasurer, on the group’s tax return for 2011, the latest on file with GuideStar, an online database on nonprofits. The tax return put 2011 revenues at $595,904 and expenditures and disbursements at $267,836. Revenue included a $300,675 contribution from a tax-exempt trust called Fata 2011 Grantor Charitable Lead Annuity with the same address as Dr. Fata’s home in Oakland Charter Township, Michigan. Total assets for Swan for Life at the end of 2011 were valued at $950,954.
Head-Injured Patient Had to Receive Chemo Before ED Trip
The criminal complaint filed against Dr. Fata on Tuesday said that his practice, MHO, billed Medicare $35 million over the course of 2 years. Of that amount, roughly $25 million was billed specifically by Dr. Fata. Almost all of that $25 million was for drug infusions, the highest amount billed for those services by any hematologist-oncologist in Michigan.
It is not clear how long federal authorities have scrutinized Dr. Fata. One court document filed by prosecutors called the investigation “very brief.” The complaint suggests that the government has moved with extreme urgency. The allegations against Dr. Fata come from 8 current or former employees, all of whom were interviewed earlier this month. Only 7 such individuals, all unnamed, are mentioned in the complaint, however. Of these, 6 were interviewed the day before Dr. Fata was arrested as federal agents raided his home and office.
“Our first priority is patient care,” said US District Attorney Barbara McQuade in a news release. “The agents and attorneys acted with a great attention to detail to stop these allegedly dangerous practices as quickly as possible.”
Many of the allegations center on Dr. Fata’s use of chemotherapy, and in particular, administering it to patients who did not need it. One NP told federal agents that “Dr. Fata falsified cancer diagnoses to justify cancer treatment” and that blood cancers were easier to falsify than tumors because physicians have more discretion to interpret blood tests. This NP and other employees also said that patients whose cancer was in remission were put on “maintenance” doses of chemotherapy. A medical assistant quoted Dr. Fata as telling patients that once they had chemotherapy, “they had to have it for the rest of their lives.”
Dr. Fata also ordered chemotherapy for all patients with advanced cancer who would not benefit from it, according to the employed oncologist interviewed by federal agents. “No other physician would do this and would let the patients die in peace,” the complaint quotes the oncologist as saying. In April 2012, the American Society of Clinical Oncology said that administering chemotherapy to patients with advanced cancer who would not benefit from it is 1 of 5 practices that oncologists must abandon.
The current and former employees paint a picture of a physician who was obsessed with administering chemotherapy, no matter the circumstances. “A male patient fell down and hit his head when he came to MHO,” the complaint alleged. “Dr. Fata directed [an NP] that he must receive his chemotherapy before he could be taken to the emergency room.” Dr. Fata’s order was carried out. The man eventually died from the head injury.
In another alleged incident, a patient with extremely low and potentially fatal levels of sodium was given chemotherapy before he could go the emergency department, as ordered by Dr. Fata.
Doses of chemotherapy were excessive as well, according to the employed oncologist at MHO. For example, Dr. Fata would order 56 doses of rituximab (Rituxan, Genentech) over the course of 2 years for a patient with non-Hodgkin’s lymphoma compared with 12 doses that a “normal oncologist” might order.
Dr. Fata Owned Firm That Did PET Scans, Complaint Says
Current and former employees of Dr. Fata describe other practice patterns that are hallmarks of Medicare fraud cases:

• Unusually high patient volume: One employee said Dr. Fata saw 30 to 60 patients per day. Three other employees put the count at 50 to 70. Several said that Dr. Fata could sustain this pace because he used unlicensed foreign physicians to conduct examinations that typically lasted several hours. Then Dr. Fata would pop in at the end.
• Upcoding: One NP told federal agents that Dr. Fata “bills every patient at the highest possible code, even though he only spends 3 to 5 minutes with them.”
• Interlocking services: The criminal complaint states that Dr. Fata incorporated a company called United Diagnostics in November 2012. According to a business office employee interviewed by federal agents, all the PET scans ordered by Dr. Fata were performed at United Diagnostics. Another employee said that the percentage of Dr. Fata’s patients who received PET scans increased from 30% to 70% once United Diagnostics opened for business. Likewise, Dr. Fata started a pharmacy in 2012, and he instructed MHO employees to make it their sole source for oral chemotherapy drugs.

In addition, the complaint alleges problems that could be classified as simply careless medicine.

• Dr. Fata performed bone marrow biopsies assisted by medical assistants who were not wearing gloves.
• Patients sometimes received the wrong medicine, or medicines out of sequence, because of poor record-keeping.
• At one time, patients received chemotherapy without a physician present.

Barbara McQuade, the US district attorney based in Detroit, has established a hotline (1-888-702-0553) for patients who have questions about their medical record or information to share with investigators. The US Department of Justice told Medscape Medical News it could not reveal the number of patients who have called the hotline.