More reasons to prioritize safety threat cases

Farid Fata, M.D., the notorious oncologist facing imprisonment for healthcare fraud, is back in the headlines. Michigan attorney Donna McKenzie recently filed civil lawsuits on behalf of 11 patients who allegedly received unnecessary chemotherapy from Fata, CBS News reported. One patient later died of an illness that may have been linked to Fata's services.

Conduct alleged in the government's case against Fata is shocking. He's accused of providing chemotherapy to patients whose cancer was in remission, deliberately misdiagnosing patients with cancer to collect payment for unnecessary care and subjecting end-of-life patients to chemotherapy when they had little to gain from it. Fata is also accused of knowingly misdiagnosing cancer-free patients to justify testing, fabricating diagnoses to support needless hematology treatments and distributing controlled substances unnecessarily or at dangerous levels, according to the U.S. Department of Justice. Fata has denied wrongdoing.  

A nurse Fata employed audited medical records for 40 of his patients and found that 95 percent received improper treatment, as FierceHealthPayer: Anti-Fraud reported. One patient received 155 chemotherapy treatments in two and a half years although he was cancer free, according to CBS.            

"…[C]hemotherapy is a highly toxic medication," McKenzie told CBS, "and so, as these people were going through their treatments, they got severely ill. Some resulted in multiple hospitalizations and they still were given chemotherapy even when they were at their…sickest state."

Many fraud schemes threaten patient safety. Medicare patients at Chicago's Sacred Heart Hospital, for example, received invasive procedures they didn't need, including prolonged sedation, tracheotomies and penile implants, as FierceHealthPayer: Anti-Fraud reported. Hospital physician Vittorio Guerriero, M.D. allegedly induced breathing complications in at least 28 patients to justify drilling holes in their throats, Listverse reported. Five people died as a result.

Yet another patient safety risk is the growing frequency of healthcare services provided by unlicensed people.

There are urgent messages for fraud fighters here.

First--and most obviously--fraud that puts patients in harm's way should be a top priority for special investigations units (SIU). Safety protection should be a specialty within the profession. Designated SIU staff should coordinate with clinicians on this, scanning the skies for problems and local appearances of safety-related issues prosecuted elsewhere.

Secondly, it's interesting that there was no whistleblower in Fata's case. Someone must have suspected problems in the six years his alleged scheme ran; but witnessing a crime and choosing to report it are horses of a different color. Fata's case shows that fraud fighters can't wait for complaints to arrive to ferret out and move against aberrant providers.

Fata's case also shows a need to publicize confirmatory consultation benefits. Insurers should encourage members to get second opinions not just before elective surgery, but before any significant healthcare service or treatment. Think about it: What if Fata's cancer-free patients had sought second opinions from other oncologists before receiving chemotherapy from him? Medicare paid Fata more than $48 million for chemotherapy or other cancer treatment drugs. Well-timed consultations may have reduced the overpayment and spared patients the trauma of needlessly-infused drugs.  

Finally, cases like Fata's can provide motivational fuel for SIU professionals, making the significance of their work clear.  

It's difficult to investigate and resolve complex healthcare fraud cases. Fraud fighting requires endurance and commitment. Why do we care about transitioning into prepayment techniques? Why do we spend long hours looking for links between people and events to uncover new scams? Why do we chase leads and educate stakeholders about fraud? Because people are vulnerable to harm by criminals who use them to make money. And that's a good reason for SIUs to embrace their role, even when the job is long and relentless and complex. - Jane (@HealthPayer)