Michigan doctor arrested for purposely misdiagnosing cancer
by Jen Hayden
Daily Kos
Aug 07, 2013
Greed knows no bounds. It pushes people to do unspeakable things. For Dr. Farid Fata, a Michigan oncologist, there were no limits:
Dr. Farid Fata, 48, of Oakland Township was arrested Tuesday and charged for allegedly submitting false claims to Medicare for services that were medically unnecessary, including chemotherapy treatments, Positron Emission Tomograph (PET) scans and a variety of cancer and hematology treatments for patients who did not need them. Dr. Fata owns and operates Michigan Hematology Oncology Centers (MHO) which has offices in Clarkston, Bloomfield Hills, Lapeer, Sterling Heights, Troy and Oak Park.
Dr. Fata was scamming Medicare to the tune of $35 million.
In the course of the scheme, prosecutors say Dr. Fata falsified and directed others to falsify documents. MHO billed Medicare for approximately $35 million dollars over a two-year period, approximately $25 of which is attributable to Dr. Fata, federal officials said.
The complaint further alleges that Dr. Fata directed the administration of unnecessary chemotherapy to patients in remission; deliberate misdiagnosis of patients as having cancer to justify unnecessary cancer treatment; administration of chemotherapy to end-of-life patients who will not benefit from the treatment; deliberate misdiagnosis of patients without cancer to justify expensive testing; fabrication of other diagnoses such as anemia and fatigue to justify unnecessary hematology treatments, and distribution of controlled substances to patients without medical necessity or are administered at dangerous levels.
Dr. Fata was prescribing painful and unnecessary treatments to patients:
The feds say he also deliberately misdiagnosed patients “as having cancer to justify unnecessary cancer treatment,” WXYZ reported.
Federal agents say Fata directed the “administration of chemotherapy to end-of-life patients who [would] not benefit from the treatment,” and deliberately misdiagnosed “patients without cancer to justify expensive testing.”
Thankfully, Dr. Fata isn't likely to get out of jail any time soon:
Dr. Fata faced a federal magistrate Tuesday afternoon. Assistant U. S. Attorneys assigned to the case argued Fata is a flight risk because he has access to about $14 million in liquid assets and a home in Lebanon. The magistrate is temporarily detaining Fata until another hearing can be held on Thursday. He faces up to 20 years behind bars if he’s convicted.
Twenty years? Not long enough. Not nearly long enough.
Showing posts with label Medicare. Show all posts
Showing posts with label Medicare. Show all posts
Monday, August 12, 2013
Monday, October 15, 2012
Non-Partisan Kaiser Foundation Says 60% Of Seniors Would Pay More For Medicare Under Romney-Ryan Voucher Plan
It's Official: Non-Partisan Kaiser Foundation Says 60% Of Seniors Would Pay More For Medicare Under Romney-Ryan Voucher Plan
Rick Ungar
Forbes
10/15/2012
A new study out today by the non-partisan Kaiser Family Foundation confirms what many have been saying for a very long time—the Romney-Ryan Medicare plan would result in six out of ten seniors paying substantially more for the same Medicare benefits they receive today.
The premium support approach to Medicare involves the government providing seniors with a set amount of money each year—pegged to the second lowest priced private health care plan available—in an effort to turn over health care for seniors to the private insurance market. While proponents of the approach believe that this will generate more competition in health care, make seniors more responsible for how they spend their health care dollars and result in less spending on seniors by the federal government, critics have argued that the sum of money the government would pay would be insufficient to cover the rising costs of health care, leaving seniors exposed to having to pay an ever growing portion of their health insurance coverage.
According to Kaiser, the premium support approach (often referred to as a voucher plan) to Medicare—the hallmark of the Paul Ryan Medicare plan that has been endorsed and adopted by Governor Romney—would mean higher premium costs for more than half of beneficiaries currently enrolled in traditional Medicare—if such a program were in place today—while raising the costs for nearly all of those who participate in a Medicare Advantage program.
The study further found that the additional costs to seniors would vary from region to region, with areas of high per-capita Medicare spending seeing a cost boost for 80 percent of Medicare recipients.
While the Obama campaign was quick to trumpet the results of the study as further proof that the Romney-Ryan plan would mean dramatically higher costs to seniors when it comes to their healthcare, the Romney campaign fired back, noting that the Kaiser report says that it is not intend to model any specific proposal of either campaign.
The Romney troops are right to a point—but they somehow failed to fully quote what the Kaiser Family Foundation had to say, no doubt an inadvertent error that we shall seek to correct here—
“The analysis does not attempt to model any specific proposal, but is generally based on an approach included in House Budget Chairman Paul Ryan’s fiscal year 2013 budget plan (emphasis added), the proposal Chairman Ryan co-sponsored with Senator Ron Wyden of Oregon, and; in the plan put forward by former Senator Pete Domenici and Dr. Alice Rivlin. In the first two proposals, people who are at least 55 years old, including current beneficiaries, would be exempt from the new system. Republican presidential nominee Gov. Mitt Romney has supported a premium-support system along these lines. (emphasis added.)”
Here are the bullet points of the study results, including how you might be affected based on where you live:
Nearly six in 10 Medicare beneficiaries nationally could face higher premiums for Medicare benefits, assuming current plan preferences, including more than half of beneficiaries enrolled in traditional Medicare and almost nine in 10 Medicare Advantage enrollees. Even if as many as one-quarter of all beneficiaries moved into a low-cost plan offered in their area, the new system would still result in more than a third of all beneficiaries facing higher premiums.
Premiums for traditional Medicare would vary widely based on geography under the proposed premium support system, with no increase for beneficiaries living in Alaska, Delaware, Hawaii, Wyoming and the District of Columbia, but an average increase of at least $100 per month in California, Florida, Michigan, New Jersey, Nevada and New York. Such variations would exist even within a state, with traditional Medicare premiums remaining unchanged in California’s San Francisco and Sacramento counties and rising by more than $200 per month in Los Angeles and Orange counties.
At least nine in 10 Medicare beneficiaries in Connecticut, Florida, Massachusetts and New Jersey would face higher premiums in their current plan. Many counties in those states have relatively high per-beneficiary Medicare spending, which would make it more costly to enroll in traditional Medicare rather than one of the low-bidding private plans in those counties. In contrast, in areas with relatively low Medicare per-capita spending, it could be more costly to enroll in a private plan.
For those who may not follow health care policy closely, the Kaiser Family Foundation is one of the few independent think tanks that neither side of the political aisle is likely to criticize for being partisan as the organization’s record for impartiality is so well established. This would explain why the Romney campaign has chosen to attempt to distinguish the report from their plan (although there little to distinguish the Romney-Ryan Medicare plan from the model studied by Kaiser) rather than attack the findings of the Kaiser Family Foundation report.
Rick Ungar
Forbes
10/15/2012
A new study out today by the non-partisan Kaiser Family Foundation confirms what many have been saying for a very long time—the Romney-Ryan Medicare plan would result in six out of ten seniors paying substantially more for the same Medicare benefits they receive today.
The premium support approach to Medicare involves the government providing seniors with a set amount of money each year—pegged to the second lowest priced private health care plan available—in an effort to turn over health care for seniors to the private insurance market. While proponents of the approach believe that this will generate more competition in health care, make seniors more responsible for how they spend their health care dollars and result in less spending on seniors by the federal government, critics have argued that the sum of money the government would pay would be insufficient to cover the rising costs of health care, leaving seniors exposed to having to pay an ever growing portion of their health insurance coverage.
According to Kaiser, the premium support approach (often referred to as a voucher plan) to Medicare—the hallmark of the Paul Ryan Medicare plan that has been endorsed and adopted by Governor Romney—would mean higher premium costs for more than half of beneficiaries currently enrolled in traditional Medicare—if such a program were in place today—while raising the costs for nearly all of those who participate in a Medicare Advantage program.
The study further found that the additional costs to seniors would vary from region to region, with areas of high per-capita Medicare spending seeing a cost boost for 80 percent of Medicare recipients.
While the Obama campaign was quick to trumpet the results of the study as further proof that the Romney-Ryan plan would mean dramatically higher costs to seniors when it comes to their healthcare, the Romney campaign fired back, noting that the Kaiser report says that it is not intend to model any specific proposal of either campaign.
The Romney troops are right to a point—but they somehow failed to fully quote what the Kaiser Family Foundation had to say, no doubt an inadvertent error that we shall seek to correct here—
“The analysis does not attempt to model any specific proposal, but is generally based on an approach included in House Budget Chairman Paul Ryan’s fiscal year 2013 budget plan (emphasis added), the proposal Chairman Ryan co-sponsored with Senator Ron Wyden of Oregon, and; in the plan put forward by former Senator Pete Domenici and Dr. Alice Rivlin. In the first two proposals, people who are at least 55 years old, including current beneficiaries, would be exempt from the new system. Republican presidential nominee Gov. Mitt Romney has supported a premium-support system along these lines. (emphasis added.)”
Here are the bullet points of the study results, including how you might be affected based on where you live:
Nearly six in 10 Medicare beneficiaries nationally could face higher premiums for Medicare benefits, assuming current plan preferences, including more than half of beneficiaries enrolled in traditional Medicare and almost nine in 10 Medicare Advantage enrollees. Even if as many as one-quarter of all beneficiaries moved into a low-cost plan offered in their area, the new system would still result in more than a third of all beneficiaries facing higher premiums.
Premiums for traditional Medicare would vary widely based on geography under the proposed premium support system, with no increase for beneficiaries living in Alaska, Delaware, Hawaii, Wyoming and the District of Columbia, but an average increase of at least $100 per month in California, Florida, Michigan, New Jersey, Nevada and New York. Such variations would exist even within a state, with traditional Medicare premiums remaining unchanged in California’s San Francisco and Sacramento counties and rising by more than $200 per month in Los Angeles and Orange counties.
At least nine in 10 Medicare beneficiaries in Connecticut, Florida, Massachusetts and New Jersey would face higher premiums in their current plan. Many counties in those states have relatively high per-beneficiary Medicare spending, which would make it more costly to enroll in traditional Medicare rather than one of the low-bidding private plans in those counties. In contrast, in areas with relatively low Medicare per-capita spending, it could be more costly to enroll in a private plan.
For those who may not follow health care policy closely, the Kaiser Family Foundation is one of the few independent think tanks that neither side of the political aisle is likely to criticize for being partisan as the organization’s record for impartiality is so well established. This would explain why the Romney campaign has chosen to attempt to distinguish the report from their plan (although there little to distinguish the Romney-Ryan Medicare plan from the model studied by Kaiser) rather than attack the findings of the Kaiser Family Foundation report.
Sunday, August 12, 2012
Kaiser gave patient incorrect instructions, costing patient over $1,000
Kaiser Permanente
scambook
Complaint 139447
Date Occurred:03/01/2012
Reported Damages: $1,474.00
I was sent to RAI by Kaiser Permanente 12/12011 to initial renal dialysis. I was approached there by Peter Carrion, a representative from Kaiser, to enroll me in a Kaiser supplemental plan to start when Medicare became effective. I advised Mr Carrion I would be a home hemodialysis patient.
He instructed me to send my enrollment forms for the supplemental Kaiser plan 2 weeks before starting home hemodialysis. I started home hemodialysis classes 1-23-12, and began dialysis at home 2-16-12. I received a Medicare card with an effective date 3-1-12. I called Mr. Carrion and asked him if the effective date was correct as I understood Medicare became effective upon starting home hemodialysis.
He stated Medicare became effective 90 days after the onset of dialysis. I questioned him further but he insisted this was the case. I then accessed a web site for Medicare recepients which states that Medicare is effective the 1st day of the month that home hemodialysis classes are initiated.
I called and fax'd this information to Mr Carrion on numerous occasions without response. I then contacted his supervisor, Norma.
Norma states it was not their responsibility to know when Medicare became effective, that was up to the Social Security office. She was not interested in connecting the timing of the enrollment forms being sent to when the Medicare was made effective. I called the Social Security office who requested documentation from the Kaiser Permanente approved provider who initiated my home hemodialysis classes. This was done, I was advised it would take 6-8 weeks for my card to be corrected. I received my new Medicare card with efffective date 1-1-12 in April. Kaiser has since billed Medicare and received payment for services provided after 1-1-12.
Kaiser will not, however, refund premiums of $747/month for January and February of 2012 as my enrollment forms were not submitted until 2-1-12 as instructed by Mr. Carrion, their representative, and my Medicare was not started due to inaccurate information received from RAI, the Kaiser approved dialysis provider. It wasn't until I intervened that this was corrected. I believe Kaiser should be responsible for the instructions given to applicants and the Social Security office.
Respectfully submitted,
Anonymous SBID #8cab002602
Posted 07/26/2012
scambook
Complaint 139447
Date Occurred:03/01/2012
Reported Damages: $1,474.00
I was sent to RAI by Kaiser Permanente 12/12011 to initial renal dialysis. I was approached there by Peter Carrion, a representative from Kaiser, to enroll me in a Kaiser supplemental plan to start when Medicare became effective. I advised Mr Carrion I would be a home hemodialysis patient.
He instructed me to send my enrollment forms for the supplemental Kaiser plan 2 weeks before starting home hemodialysis. I started home hemodialysis classes 1-23-12, and began dialysis at home 2-16-12. I received a Medicare card with an effective date 3-1-12. I called Mr. Carrion and asked him if the effective date was correct as I understood Medicare became effective upon starting home hemodialysis.
He stated Medicare became effective 90 days after the onset of dialysis. I questioned him further but he insisted this was the case. I then accessed a web site for Medicare recepients which states that Medicare is effective the 1st day of the month that home hemodialysis classes are initiated.
I called and fax'd this information to Mr Carrion on numerous occasions without response. I then contacted his supervisor, Norma.
Norma states it was not their responsibility to know when Medicare became effective, that was up to the Social Security office. She was not interested in connecting the timing of the enrollment forms being sent to when the Medicare was made effective. I called the Social Security office who requested documentation from the Kaiser Permanente approved provider who initiated my home hemodialysis classes. This was done, I was advised it would take 6-8 weeks for my card to be corrected. I received my new Medicare card with efffective date 1-1-12 in April. Kaiser has since billed Medicare and received payment for services provided after 1-1-12.
Kaiser will not, however, refund premiums of $747/month for January and February of 2012 as my enrollment forms were not submitted until 2-1-12 as instructed by Mr. Carrion, their representative, and my Medicare was not started due to inaccurate information received from RAI, the Kaiser approved dialysis provider. It wasn't until I intervened that this was corrected. I believe Kaiser should be responsible for the instructions given to applicants and the Social Security office.
Respectfully submitted,
Anonymous SBID #8cab002602
Posted 07/26/2012
Wednesday, November 2, 2011
Kaiser Foundation Health Plan Inc. penalized $1.9 million for improper Medicare claims
Kaiser penalized $1.9 million
Pacific Business News
April 15, 2005
The U.S. and state attorneys general have penalized Kaiser Foundation Health Plan Inc., Kaiser Foundation Hospitals and the Hawaii Permanente Medical Group $1.9 million for making improper Medicare and Medicaid claims.
Kaiser was penalized $1 million for submitting false federal Medicare claims and $900,000 for improper state Medicaid claims.
A Kaiser employee claimed that an employee in the dermatology department had treated patients without a required state license between May 1984 and December 2001, which was confirmed by the Medicaid Fraud Control Unit, state Attorney General Mark Bennett announced Thursday.
The state said the employee who provided the treatment wasn't a licensed physician's assistant although Kaiser billed the state Medicaid program for the services provided.
The state also found that Kaiser failed to properly supervise the treatments, although the investigation didn't reveal any evidence of improper care, substandard treatment or injury to Kaiser patients.
"We take regulatory compliance very seriously at Kaiser Permanente and we regret the mistake," said Jan Head, Kaiser president.
Kaiser says the inaccurate billings to Medicare and Medicaid occurred after the state created a certification requirement for physician assistants and that the dermatology assistant practiced at Kaiser prior to the change and failed to obtain a license after the requirement went into effect.
The whistle-blowing employee filed suit in federal court under the federal and state false claims act and will receive $225,000 of the $900,000 for informing the state.
The Medicaid program will receive $115,379 for claims made based on service provided by the unlicensed service provider and the Medicaid Investigations Recovery Fund will receive $559,621 that will be used to pay for future investigations.
Pacific Business News
April 15, 2005
The U.S. and state attorneys general have penalized Kaiser Foundation Health Plan Inc., Kaiser Foundation Hospitals and the Hawaii Permanente Medical Group $1.9 million for making improper Medicare and Medicaid claims.
Kaiser was penalized $1 million for submitting false federal Medicare claims and $900,000 for improper state Medicaid claims.
A Kaiser employee claimed that an employee in the dermatology department had treated patients without a required state license between May 1984 and December 2001, which was confirmed by the Medicaid Fraud Control Unit, state Attorney General Mark Bennett announced Thursday.
The state said the employee who provided the treatment wasn't a licensed physician's assistant although Kaiser billed the state Medicaid program for the services provided.
The state also found that Kaiser failed to properly supervise the treatments, although the investigation didn't reveal any evidence of improper care, substandard treatment or injury to Kaiser patients.
"We take regulatory compliance very seriously at Kaiser Permanente and we regret the mistake," said Jan Head, Kaiser president.
Kaiser says the inaccurate billings to Medicare and Medicaid occurred after the state created a certification requirement for physician assistants and that the dermatology assistant practiced at Kaiser prior to the change and failed to obtain a license after the requirement went into effect.
The whistle-blowing employee filed suit in federal court under the federal and state false claims act and will receive $225,000 of the $900,000 for informing the state.
The Medicaid program will receive $115,379 for claims made based on service provided by the unlicensed service provider and the Medicaid Investigations Recovery Fund will receive $559,621 that will be used to pay for future investigations.
Friday, October 7, 2011
Many U.S. surgeries on elderly may be unwanted: study
Many U.S. surgeries on elderly may be unwanted: study
Oct 6, 2011
(Reuters) - One out of three elderly Americans covered under Medicare plans undergo surgery in the last year of their life, a new study shows.
Medicare reimbursement and the availability of hospital beds are more likely to influence a doctor's decision to operate than a patient's need or desire, according to the study published in the latest issue of Britain's Lancet medical journal.
"While some of these surgeries are clearly needed and helpful to patients, probably a substantial portion are not," lead researcher Ashish Jha of the Harvard School of Public Health told Reuters.
"We (physicians) don't really ask patients what they want and we end up doing a lot of procedures," he said.
The number of patients receiving surgery toward the end of their lives is higher in regions with high total Medicare spending, the study found.
For example, the rate of end of life surgeries was three times greater in the Munster, Indiana region than in Honolulu.
The study, which looked at data from more than 1.8 million beneficiaries of the government's Medicare health plan who were aged 65 years or older and died in 2008, also found that about one in five elderly patients underwent a surgical procedure in the last month of life.
Doctors should consider the benefits of surgery on elderly patients more carefully before performing procedures that may not improve their quality of life, Jha concluded.
In addition to regional differences, the study found decisions to perform surgery on elderly Americans during the last year of their lives are more likely to be influenced by the patient's age than a patient's need or desire for such procedures.
The likelihood of undergoing a surgical procedure declined significantly as patients get older, Jha's team found.
About 38 percent of patients underwent surgery at age 65, 35 percent by age 80, while only 24 percent had surgery when they lived to between the ages of 80 and 90.
Jha said physicians need to talk to patients who are about to die and inform them that a procedure may not necessarily improve their quality of life.
Oct 6, 2011
(Reuters) - One out of three elderly Americans covered under Medicare plans undergo surgery in the last year of their life, a new study shows.
Medicare reimbursement and the availability of hospital beds are more likely to influence a doctor's decision to operate than a patient's need or desire, according to the study published in the latest issue of Britain's Lancet medical journal.
"While some of these surgeries are clearly needed and helpful to patients, probably a substantial portion are not," lead researcher Ashish Jha of the Harvard School of Public Health told Reuters.
"We (physicians) don't really ask patients what they want and we end up doing a lot of procedures," he said.
The number of patients receiving surgery toward the end of their lives is higher in regions with high total Medicare spending, the study found.
For example, the rate of end of life surgeries was three times greater in the Munster, Indiana region than in Honolulu.
The study, which looked at data from more than 1.8 million beneficiaries of the government's Medicare health plan who were aged 65 years or older and died in 2008, also found that about one in five elderly patients underwent a surgical procedure in the last month of life.
Doctors should consider the benefits of surgery on elderly patients more carefully before performing procedures that may not improve their quality of life, Jha concluded.
In addition to regional differences, the study found decisions to perform surgery on elderly Americans during the last year of their lives are more likely to be influenced by the patient's age than a patient's need or desire for such procedures.
The likelihood of undergoing a surgical procedure declined significantly as patients get older, Jha's team found.
About 38 percent of patients underwent surgery at age 65, 35 percent by age 80, while only 24 percent had surgery when they lived to between the ages of 80 and 90.
Jha said physicians need to talk to patients who are about to die and inform them that a procedure may not necessarily improve their quality of life.
Sunday, May 15, 2011
We pay hospitals more if they injure patients
Hospitals to get cash boost for better care
Apr 29, 2011
Reuters
Hospitals that improve medical care for elderly patients, and reduce deadly errors, will get millions of dollars under an incentive program launched on Friday that aims to cut overall Medicare costs.
The government healthcare program for seniors spent about $4.4 billion in 2009 to care for patients who were harmed in the hospital, according to the Centers for Medicare and Medicaid Services (CMS)...
Apr 29, 2011
Reuters
Hospitals that improve medical care for elderly patients, and reduce deadly errors, will get millions of dollars under an incentive program launched on Friday that aims to cut overall Medicare costs.
The government healthcare program for seniors spent about $4.4 billion in 2009 to care for patients who were harmed in the hospital, according to the Centers for Medicare and Medicaid Services (CMS)...
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