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June 16, 2015

How one doctor exposed his boss's 'evil' acts: Giving chemo to healthy patients

Daily Briefing

When a doctor at now-shuttered Michigan Hematology and Oncology (MHO) discovered his boss was prescribing cancer medications to a healthy patient, he vowed to bring his employer to justice—no matter the cost, Laura Berman writes for the Detroit News.

Initial distrust

In 2013, MHO was Michigan's largest private cancer practice, comprised of seven clinics and about 1,700 patients. Farid Fata, who had trained at Memorial Sloan-Kettering Cancer Center, operated the practice and oversaw a large group of physicians.

When oncologist Soe Maunglay first arrived at MHO, he observed that the practice appeared disorganized and sought to enact several changes. He urged Fata to require a physician to be present during the administration of chemotherapy. Fata agreed—but also moved Maunglay to different offices, where the two doctors would not overlap in terms of patients or hours.

Maunglay eventually caught Fata in a lie, when his boss claimed that the organization had certain certifications—which Maunglay knew was not true.

Deciding that his boss had "no ethics [and] no professionalism," Maunglay gave notice of his resignation, effective Aug. 9, 2013.

The visit that changed everything

But several weeks before Maunglay's scheduled departure, he encountered a patient who shouldn't have been a patient at all.

During Maunglay's rounds in July 2013, he met Monica Flagg—who was months-in to treatment for multiple myeloma, an incurable and oft-fatal form of cancer of the plasma cells in bone marrow, and had just broken her leg.

But as Maunglay read her chart, he discovered all of the readings to be normal: Flagg did not appear to have cancer.  

In fact, Flagg's levels of M protein were slightly elevated and could qualify as MGUS—an early-stage condition that can be considered as precancerous but is often not.

Yet Flagg had been diagnosed by Fata with smoldering myeloma, a more serious version of the disease that required hefty treatment. Fata conducted three bone marrow biopsies on Flagg and prescribed monthly intravenous immunoglobin injections (IVIGs)—each costing nearly $4,000. Ten months later, Fata diagnosed her with multiple myeloma, which would require lifelong treatment.

Reviewing Flagg's file, Maunglay was unable to find justification for her current course of treatment. And because of the subjective nature of the diagnosis, Maunglay believed Fata could have selected the diagnosis in order to protect himself from future inquires.

"Every test result in the medical history confirmed his original reaction in the hospital: Flagg was being deliberately treated with high-risk drugs for a disease she did not have," Berman writes.

Later, when Maunglay followed up with Flagg, he insisted she get a second opinion.

"For me, one case like this was enough," adding, "If he can do this to a person who has nothing..." what more could he be capable of, remembers Maunglay.

Why second opinions are getting a second look

'The tip of the iceberg'

After uncovering Fata's intentional misdiagnosis, Maunglay couldn't sleep, and suspected Flagg's story might "be the tip of the iceberg." He began mining patient files for more evidence that Fata had breached medical and professional ethics. For instance, Maunglay found that Fata had excessively prescribed IVIGs for many patients without a medical basis.

Working with practice manager George Karadsheh, who acted as whistleblower, Maunglay reported Fata to the Federal Bureau of Investigation (FBI) on August 2, 2013.

On August 5, FBI and HHS officials arrived at Maunglay's house, where he laid out everything he had found on Fata's wrongdoings.

Arrests, sanctions didn't stop doctors from getting Medicare dollars

The next morning, Fata was arrested. "They did not let another drop of chemo go into anyone. They just pulled the plug," Maunglay says.

In September 2014, Fata pleaded guilty to numerous counts of Medicare and insurance fraud, soliciting kickbacks, and money laundering, and admitted publically that he had recommended medically unnecessary treatments. He is expected in court July 6 and federal prosecutors are asking for a life sentence.

"I have been doing this for 30 years and this is some of the most evil conduct I have ever seen," says Brian McKeen, the malpractice attorney representing Flagg in a separate suit.

"He let greed cloud his clinical judgment."

Maunglay's repercussions

After the ordeal, Maunglay took a job offer from McLaren-Lapeer/Karmanos Cancer Center, but he still worries that his name will forever be associated with Fata's.

"They say that he (Maunglay) is the whistleblower, but I am still suspicious. His name is all over the charts," says Geraldine Parkin, whose husband was one of Fata's patients. She now leads the advocacy group Patients and Families Treated by Dr. Fata.

Maunglay contends "it was just not that easy to know," because he had little access to Fata's patients.

Despite any repercussion that may come, Maunglay says he does not regret his decision to call attention to Fata's scheme.

And his new employer has praised Maunglay's courage. "He saved people's lives. It goes to the fiber and testament of the man. He's a hero," says McLaren-Lapeer Regional Hospital CEO Bart Buxton (Berman, Detroit News, 6/10).

The takeaway: In an in-depth report for the Detroit News, Laura Berman talks with physician Soe Maunglay who blew the whistle on his former employee—eventually uncovering more than $35 million in Medicare fraud—on how he uncovered one of the most heartless fraud schemes ever reported.

How hospitals can prevent fraud (and address fraud allegations)

Health care fraud—from Fata's case to a hospital president who ran a $158 million fraud scheme—is unfortunately common across the industry.

And whether they involve top executives or low-level employees, fraud allegations can bring costly lawsuits and a hit to the reputation of any a health care organization.

The Daily Briefing's Clare Rizer sat down with attorney Lisa Gingerich of von Briesen & Roper, s.c. to identify ways that hospitals and physician practices can prevent fraudulent acts from occurring in medical settings or how to nip them in the bud before they become large-scale issues.

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