Whistleblowers Risk Their Careers to Expose Medicare Fraud

[00:00:00] Bob Sullivan: When Dr. Soe Maunglay takes a job in the state of Michigan’s largest private cancer practice, he plans to start a new life near Detroit. His wife had just taken a residency in radiology nearby. Maunglay was going to work for Dr. Farid Fata, a bit of a local legend in oncology circles. Instead, Maunglay is about to discover a truth so awful he can barely sleep. Fata had been putting healthy patients through grueling chemotherapy treatments, sometimes for months or even years, just to collect Medicare payments. As the Detroit Times put it later, “Fata had to dispensed cruelty as casually as Tylenol.” But after this nauseating discovery Maunglay faces the professional challenge of a lifetime. How can this young cancer doctor turn in his boss? Who will believe him? He’s about to risk everything he’s ever worked for to save patients at the clinic from suffering. Welcome back to The Perfect Scam. This is part 2 of our story Dr. Rotten. If you didn’t listen to part 1 please go back and do that. This story is so important, we’ve gone into the archives and we’re giving it a second airing here in The Perfect Scam feed. Will Johnson is your host.

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[00:01:23] Will Johnson: This week we're bringing you the story of a massive Medicare fraud scam that touched the lives of so many people. To help us wade through the universe of Medicare fraud and scams, we've brought in a renowned expert this week. Peggy Pasado is joining us. She was with the Department of Justice for many years, and uh worked on the, the Medicare Strike Team. Peggy you can tell us more about it. Peggy, I have a quote that says you single-handedly saved taxpayers billions of dollars in your time with the Department of Justice. First of all, thanks for doing that.

[00:1:55] Peggy Pasado: You're welcome. Ah yes, I did, I did do that.

[00:01:58] Will Johnson: You are our Medicare expert because this stuff gets a little complicated. Set the stage for us a little bit. What does Medicare fraud mean, really? I mean if you can sort of give it a definition.

[00:02:08] Peggy Pasado: Well let me kind of break it down because when they talk fraud, they're talking fraud claims, fraud in essence. It's uh, any, any false, fictitious, fraudulent claim that's submitted to Medicare is Medicare fraud. What drives that, or part of what drives that is why it's, it's being listed as such. Sometimes it's because it's not medically necessary services. Sometimes it's non rendered services. Sometimes it's kickback, but all of these things all amount to false claims.

[00:02:41] Will Johnson: And who is responsible for the fraud? We've got anybody from someone like uh who we're talking about in our show, or it, could it be nurses or, I mean who's involved as far as like the bad guys go?

[00:02:57] Peggy Pasado: Basically everybody. Fraud is very impartial. I mean it's committed over all provider types, some are more frequently identified because of the egregiousness of the claim, so I, I would say over the past 10 years, probably the most egregious types would be durable medical equipment fraud and home health services. And the people who are doing that, um, are on the street. So your nurses who would be doing home health, they may not know that what they're doing is wrong, because if they didn't have some specific piece of it. Um, the ones in durable medical equipment, normally they aren't even medical personnel. I mean they could be janitors for god's sakes. So, but all of these individuals, all these provider types and the people who are working at them, are capable of doing fraud, but who actually is making out the claim is the one that you're going after.

[00:03:45] Will Johnson: All right. Up next, part two of our three-part story.

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[00:03:49] Will Johnson: Last week we told you about Angela Swantek, the oncology nurse who left a job interview at one of Fata's clinics in distress shocked by the lack of basic safety procedures for patients and a nagging suspicion that something much darker was taking place. She filed an official report with her allegations against the doctor's practice, but in a written response over a year later, she claims the State of Michigan decided nothing was wrong. We also told you about Robert Soberay, the retiring car factory worker who spent 2½ years under Fata's care, only as his body continued to deteriorate and his life unraveled. This week, we'll introduce you to a young oncologist who was starting the next phase of his career at Fata's practice only to learn the awful truth of what was happening behind the clinic doors.

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[00:04:38] Will Johnson: On a cold winter day in January 2012, a year and a half after Angela Swantek left her interview at Dr. Farid Fata's practice and filed her allegations, Dr. Soe Maunglay went in for an interview at the clinic. He was working in Florida at the time, but his wife had a new position in Michigan, and he was looking for work near the hospital where she'd be working.

[00:04:57] Dr. Maunglay: I was pleased that he had so many offices, very well organized, uh impressive offices, and apparently, I could be busy as soon as I start.

[00:05:07] Will Johnson: After a long day of touring Dr. Fata's offices and meeting staff, he finally met Dr. Fata that evening in the office kitchen.

[00:05:14] Dr. Maunglay: He was eating pizza and he seemed to me, to, you know, just he doesn't seem like the president of a big company. He looked like a, just like, you know just like us. Just like one very, one busy, tired doctor. I just don't see a big difference between a regular doctor and him, that's, that's my impression.

[00:05:31] Will Johnson: Dr. Maunglay got the job right away and made plans to wind down in Florida and start with Dr. Fata's office later that year. But before he ever started Maunglay ran into an odd situation. Fata seemed to disappear.

[00:05:44] Dr. Maunglay: I was not able to get a hold of him. He didn't give me a start date. I have, you know I have a contract without a beginning date. This is, this is very, it was very bizarre.

[00:05:55] Will Johnson: Maunglay was supposed to be part of an expansion to Fata's practice; however, he came to learn that he was actually replacing another doctor who was quitting, and he hadn't left yet. So Maunglay was left waiting for a start date and wondering if he was signing up for something he'd regret.

[00:06:10] Dr. Maunglay: And this was just, you know, just a dishonest, uh game that he played, then still I, I was kind of stuck. I have to work for him.

[00:06:19] Will Johnson: But Dr. Soe Maunglay had signed a contract. And he eventually got a start date in August 2012. He liked the location and what he'd seen so far, but he was wary after Dr. Fata's brief disappearing act.

[00:06:32] Dr. Maunglay: In so many ways that makes, makes me very aware of things around me, so I was, my guards were up. I always very careful with this guy. Something is not right on the days that I start working. So I think that's, in the short, in the end that served me well.

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[00:06:51] Will Johnson: But it was in the days and weeks to come that Dr. Maunglay would come to learn just how not right things were. As it turns out, Maunglay had just scratched the surface of Dr. Farid Fata.

[00:07:01] Dr. Maunglay: So I figured out that there are some locations that patients were receiving chemotherapy, and there was no physician present or aesthetician or any (inaudible) present.

[00:07:13] Will Johnson: In Maunglay's experience, a physician should be on hand at any locations where patients were getting chemotherapy.

[00:07:19] Dr. Maunglay: That was not happening in one or two locations. So that was the, the conflict started immediately when, you know within the first one or two weeks. Like I asked him, who's there in those locations? And he was not able to answer me, and he looked at me and then literally I think three or four days later my assignment was different. I was actually sent off to the locations that I would never, ever see him.

[00:07:42] Will Johnson: Maunglay now found himself in a new job where he had zero interaction with his boss or his boss's staff. But the trouble was just starting.

[00:07:50] Dr. Maunglay: And then there was something absolutely, absolutely bizarre, was, you know how if you're in a group practice, the purpose of having a group practice is to have some type of quality of life, right? You just, you can't work day in and day out. If somebody called you in the middle of the night, you have to answer it. You cannot be answering for every single day, so you want at least weekends off or some days off. When you're in a group practice you can sign off your pager to the answering service, to the rest of the guys who's on call.

[00:08:20] Will Johnson: But according to Maunglay, Dr. Fata never did that. Any patient under Fata's care stayed under his care. If there was an issue or problem at any time of day, Fata would respond.

[00:08:30] Dr. Maunglay: I was supposed to see a patient, I was looking at the chart and I could see the nurse sitting next to me paging him about the patient that I was about to see.

[00:08:38] Will Johnson: Oh wow.

[00:08:38] Dr. Maunglay: There was an instruction that for all his patients all the calls go to him 24/7 all the time.

[00:08:46] Will Johnson: The only way Dr. Maunglay could explain it, was that Fata was completely dedicated to his patients and his work.

[00:08:51] Dr. Maunglay: All of us have some level of Type A personality. I thought he was over the top. I thought he was, this is the kind of cancer doctor I want, I will all, this doctor will always be accessible day and night, because you don't have to explain your story to somebody else, you're always going to get a hold of your own doctor. So I'm like, this, this guy is phenomenal, but I don't think I can do this. It will be very hard. In the end it'll come back and bite him because he's going to get too tired, he's going to miss things, he's going to miss many things, so I had a meeting with him. I said, you have to sign out your pager. We need an answering service to arrange that and that was one of my requests.

[00:09:29] Will Johnson: That seems like a big step to take as like a new employee to go to your new boss and say, you've got to take a break.

[00:09:35] Dr. Maunglay: So you know, so you see the amount of tension already building. I'm like, this guy just stop. I'm the guy you're, I'm the right guy, you know, I'm the guy who's writing the checks and you're asking for this, this. You're asking to change the practice better and better. It's been successful for you know a long, long time.

[00:09:51] Will Johnson: If Fata was missing out on family time, that might have been alleviated by the fact that his wife was the Chief Financial Officer. And she was actually CFO, so not a, I mean that's a big position and one with a lot of oversight, I would imagine.

[00:10:05] Dr. Maunglay: Yeah, so I think she is in charge of all the financial aspects of the practice.

[00:10:08] Will Johnson: So Maunglay has his patients, Fata has his. And it stays that way. Maunglay is unable to convince Fata to let him cover his patients, and then Fata stops communicating directly with Maunglay altogether.

[00:10:20] Dr. Maunglay: He communicate me through nursing staff or other intermediary, always through the, okay, he would send a message through (inaudible) to do that rather than call me and say, hey, so do that. No, he doesn't do that anymore, 'cause he, he was trying to distance himself from me.

[00:10:37] Will Johnson: But despite Fata's efforts to keep his patients to himself, there were rare occasions when Maunglay would interact with Fata's patients. Maunglay starts to notice some odd things.

[00:10:46] Dr. Maunglay: Why is the patient getting 7 cycle of chemotherapy when the standard of care is 6? Why is there one more cycle, so and then, you know, the answer was well, you know, one of the cycles there was a reaction or something happened so he's trying to make up for it.

[00:11:03] Will Johnson: Maunglay is convinced Dr. Fata is way more aggressive than he would be when it comes to treatment. He talks to other oncologists in the area.

[00:11:09] Dr. Maunglay: All of them know that, oh, you know Dr. Fata is very aggressive. This is how he does. And it's not like an unknown thing, it's known to the whole community. He would take patients that other doctors stopped treating, you know, so in a sense he'd never give up.

[00:11:23] Will Johnson: Along the way, Maunglay presents another idea to Dr. Fata. He asks about submitting the practice for national oncology certification program.

[00:11:31] Dr. Maunglay: And he said, "We already have that certification." Like to my face.

[00:11:36] Will Johnson: But Maunglay knew for a fact that Fata's practice was not certified.

[00:11:39] Dr. Maunglay: How can you lie to another doctor who knows about this as much as you do? I felt very, very insulted that he, I think the way he probably was saying that this is it, and then let's not talk about it. I don't really care about your opinion, and I'm lying to you. You know that, I know that, and what do you want to do about it? That's, that's the way I felt. I'm like, oh my god, how do you like straight up lie, you know?

[00:12:01] Will Johnson: This all takes place less than a year after Maunglay joins the practice. In June of 2013, less than 10 months after starting his job, he submits his resignation. His last day is set for August 9th, 2013. But in those last weeks before Maunglay leaves for good, Dr. Fata takes a vacation going overseas to Lebanon.

[00:12:21] Dr. Maunglay: Usually Dr. Fata never took time off. He never takes vacations. I think the, the, the whole time I was there, he was out for vacation for I think one day. And this is the second time, he has a family, I think his, I don't want to say about his (inaudible), he has a family medical emergency that he had to leave the country. He went back to Lebanon. I don't know, just like last minute. So uh, finally he had to leave the pager with me, his pager. There is no, just mind you, there is no paging system. There's a physical like, like a black pager. I don't know if you've ever seen the doctors carry back in the day?

[00:12:58] Will Johnson: Sure, oh yeah.

[00:12:59] Dr. Maunglay: So that, so that's what he carries. You know my pagers come to my cell phone. He actually hold a pager, and he has to give it to me. So I carry that.

[00:13:08] Will Johnson: With Fata on vacation and his pager in hand, Maunglay is finally summoned to consult with one of Dr. Fata's patients who had fallen and broken her leg. With Fata gone, Maunglay starts reviewing her charts.

[00:13:19] Dr. Maunglay: Before I went in there, there was some mention of the patient was receiving some type of treatment in the note. We don't know what it is. I'm like, oh, what is the patient receiving? And then I went and talked to the patient, she was, she was just wearing a cast, and she said she just received chemotherapy the same week before she end up in the hospital. I said, "Why did you receive chemotherapy?" So she said, "I have multiple myeloma." And I was a little bit puzzled, because you know the, the reports, they were a few months old, seems like she has a very, very mild form of disease that she would not really have active disease or in that case, or ever you know, know, many patients have this problem.

[00:14:01] Will Johnson: With his faith in Dr. Fata at an all-time low, Maunglay is suspicious of the fact that the patent is getting chemo for what he describes as a mild condition.

[00:14:10] Dr. Maunglay: Something is not right. Something I just, I found was I think really odd around her, I didn’t say much, but I was, I can't, I can't really describe. I was just, you know, finding difficulty finding words to talk to, talk to her, because I, I knew something was not right.

[00:14:30] Will Johnson: The next day Maunglay goes to the clinic early and prints out the patients’ charts.

[00:14:33] Dr. Maunglay: So I don't have all of it, but I had enough, and my jaw dropped what happened. He saw her a few months ahead and then, and he did 2 or 3 bone marrow biopsies already which was really excessive. You don't have to do bone marrow biopsies. You can follow with blood and urine tests. And then nothing really comes up but at one point he started her on um, a few months before he started her on this expensive immunoglobulin immune supplement, uh that costs about I think 4,000 a month or something on her, without any good medical reason.

[00:15:08] Will Johnson: Maunglay is disturbed but still willing to accept that perhaps Dr. Fata had a good reason for the test and the medication, but he's unable to accept what he sees next in her charts.

[00:15:18] Dr. Maunglay: He told her that she has active multiple myeloma. And I knew the test right before that, because it's, it's, it's in the electronic medical records and some people have scanned them already, but she doesn't. Nothing really has changed. He just lied to her, but it seems like he was, he was priming her to do this for several months. That he was planning to put her on this chemotherapy of the rest of her life. You know, I'm talking about giving chemotherapy, not an antibiotic, chemotherapy to a patient who doesn't have cancer. I might be the first doctor who ever saw this. I said, no, no, no. This is not possible. This is not possible, this is not possible. And the next day I went and told the patient.

[00:16:01] Dr. Maunglay: I think deep down inside she probably knew that something was not right, and she needed to hear from another doctor, I think, because she had no resistance. She doesn't say why? She said, "Okay, doc, I'll do that."

[00:16:13] Will Johnson: Maunglay realizes he has to act and act quickly.

[00:16:16] Dr. Maunglay: I might be violating some uh, rules, practice rules, uh by looking up the patients that are not mine. Uh I decided to look into A to Z, and uh, and then something clicked.

[00:16:30] Will Johnson: Maunglay decided to hone in on one particular medication that seemed to show up on many of the patient files. From what he could tell, close to half the patients receiving the drug didn't need to be on it.

[00:16:40] Dr. Maunglay: This is the only thing that appeared to be easily provable on my end. Because you just can't say in medicine this and that, and you need a real evidence.

[00:16:50] Will Johnson: He brought it up with some of the nurses, and then asked one of them to confront Dr. Fata about the medication.

[00:16:55] Dr. Maunglay: He said, "Okay, let's cancel that." So that's admission of guilt. The only thing I needed is that if he agreed to stop a treatment just because you know, the staff said no, this might be required. If I believe, believed that this was helping my patient, I'm going to fight with the insurance company. I will fight with everybody. No, he stopped it immediately. So it's just admission of guilt, that's all I needed.

[00:17:22] Will Johnson: For Dr. Maunglay, that was the last straw. He approached the clinic's office manager, George Karache.

[00:17:28] Dr. Maunglay: I presented to our office manager who oversees 7 clinics, what my concerns are, and I presented to him.

[00:17:35] Will Johnson: We spoke to George Karache several times before he agreed to do an interview with us, not that he didn't want to. I get the sense that he's been burned before. The aspects of the story told in the press didn't match his experience. He wants to make sure we get it right.

[00:17:50] (phone ring) George Karache: Hello.

[00:17:52] Will Johnson: George, it's Will Johnson at AARP. How are you?

[00:17:55] George Karache: I'm fine, Will. How are you doing?

[00:17:57] Will Johnson: Not bad.

[00:17:58] Will Johnson: George Karache actually had an experience as a whistleblower previously in his career. Years before working as a sleep technician. He'd only been on the job a few weeks when he noticed some billing irregularities and reported it.

[00:18:09] George Karache: Two, three years later that the FBI actually came to my door.

[00:18:12] Will Johnson: Oh, that long, okay. Did they get busted for it?

[00:18:16] George Karache: Yeah, essentially, they came to my door and they wanted to know more information about what had happened, and because apparently it uh, it continued and the amount of money that we're talking about uh escalated.

[00:18:30] Will Johnson: Eventually he went to work for Dr. Farid Fata.

[00:18:32] George Karache: Well, I worked, I think it was a little bit over two years, and I was hired as the office manager.

[00:18:39] Will Johnson: In this role he worked closely with Dr. Fata almost on a daily basis.

[00:18:43] George Karache: I had to report at the end of the day, and you know fires that were brewing, the issues that had to be dealt with.

[00:18:51] Will Johnson: Karache could see from the minute he arrived at the Rochester Clinic for an interview with Dr. Fata that business was booming.

[00:18:57] George Karache: You would think that it was some sort of ski lodge or a hotel, a grand hotel. It had 50-foot ceilings, it had grand pianos, artwork. So it took me aback at the opulence of the center.

[00:19:12] Will Johnson: Unlike the cancer center, George comes to find out that Fata doesn't seem interested in the trappings of wealth, nothing that would mirror the income generated by the clinic. George tells me Fata and his wife drove late model Chevy SUVs, work modest clothing, and owned a nice home that was sparsely furnished, but the cancer center was a different story.

[00:19:30] Will Johnson: So you saw all of this and you met him and worked with him, and he was clearly successful. Would you describe him as someone who treated his staff well? Was he a friendly guy?

[00:19:39] George Karache: I wouldn't go that far. What I would say is that he was a very controlling individual, and you know, he controlled people uh with uh not just his policies and procedures, but he also controlled people with the use of cameras and microphones strategically placed in all of his centers, but not just to keep track of his patients, to keep track of his employees, to make sure they are saying the right things and they were in the right places. He didn't want nursing staff to go to the billing, he didn't want billing to go to the front office. He didn't want the doctors to mix and mingle, they were to stay where they were assigned.

[00:20:15] Will Johnson: George was also the person who helped Fata search for new staff members, and he discovers that his new boss only seems to hire inexperienced medical staff, often just out of school who never worked in a clinic outside of their school training. In fact, Fata scrutinized the photos for every candidate in the clinic with a fine-toothed comb and chose every new hire personally. It was in this closely-watched, controlled environment that George, much like Dr. Maunglay, starts to see some odd things happening as well.

[00:20:42] George Karache: Two nurse practitioners give their, their um, notice to resign very short time in-between one another, less than a month. And they were critical to the practice, and so what I did is you know I asked one of them why they were leaving, and she said, "Well it's just quality of life issues." And, and I went to Dr. Maunglay, to his office, and I asked Dr. Maunglay, "Were you aware that your staff is, that your nurse practitioner's leaving and we have another one leaving?" And he says, "Yes, I am." And I said, I asked him, "Are you leaving?" And he said, "Yes." And I said, "Can you tell me why?" And he pointed up to the ceiling, and he said, and he whispered to me, "Cameras." And that's when he said, "Let's go down to the patient resource library," and that's when he told me that everyone is leaving because of what was discovered and that Dr. Fata was giving chemotherapy to patients without need. That he was taking patients off of hospice and putting them on chemotherapy, that he was taking patients without disease and putting them on chemotherapy, basically until the last day of life.

[00:21:58] Will Johnson: And when he pointed up to the ceiling and said, "cameras," I mean clearly, he's suggesting that maybe he was under your conversation, could be surveilled, or was being...

[00:22:07] George Karache: Right, the entire office and, it is, was under surveillance and there was cameras everywhere. Everybody got used to them. We didn't, we didn't realize how many microphones until later.

[00:22:18] Will Johnson: What was that like when he, when Maunglay then told you, well you know, things are going on here that shouldn't be going on. It must have been a chilling moment for you, or you also had your own suspicions.

[00:22:28] George Karache: No, no, no. When he told me that, I, I simply didn't believe him, because I, I listened to him, and I said, well, I said, it's in my mind, I already know that Dr. Maunglay had long time concerns with Dr. Fata. Many people had disagreements with him.

[00:22:45] Will Johnson: But the conservation stuck with Karache. He decides to do his own investigation of sorts.

[00:22:50] George Karache: First thing I looked at is the patient consultation to treatment ratio. So that is, how many, how many treatments did a patient receive per doctor, right? And then compare that with Dr. Fata. So with the other doctors, out of every consultation there were 10 consultations, there was approximately 3 out of 10 that would receive treatment, and but with Dr. Fata, it was between 9 and 10. So if you're seeing Dr. Fata, you were getting treatment, it was almost automatic.

[00:23:24] Will Johnson: He doesn't stop there though. He talks to an attorney that helped him years ago in George's first whistleblower case.

[00:23:29] George Karache: I talked to him, I called him on the phone, and I explained what I had, explained my concerns, and he said, "You know, George, this sounds very serious. I appreciate what you have to understand, but what you have is sounds serious but could easily be refuted.

[00:23:44] Will Johnson: Frustrated but undeterred, George goes back to Dr. Maunglay.

[00:23:47] George Karache: I explained to him that what you said took me aback. And uh I want to know if you could elaborate on what we discussed? And he pulled out his cell phone, and on his cell phone he had pictures of patients that had been disfigured and had terrible reactions to intense chemotherapy, and he said, "This is part of that." And I said, "Well, can you share that with me?" And he said he wouldn't. And I asked him, "Why. Why wouldn't you want to share that with me?" He said, "Because George, what you know you'll be responsible for, you know, and you're better off not knowing this stuff."

[00:24:25] Will Johnson: So it was like too much of a burden to be able to live with.

[00:24:28] George Karache: It really is, and I, you know, I didn't know what his thinking was, and I certainly didn't want to work for a clinic that was doing this. But I, I, I also didn't want to make sure that in fact this was real, and it wasn't something that was a smokescreen.

[00:24:42] Will Johnson: Finally Maunglay tells Karache about a nurse in the practice who tried to take action.

[00:24:46] George Karache: He explained that someone, a nurse in a hospital caught him, caught Dr. Fata after reviewing a patient and patient's chart and confronted Dr. Fata with respect to his use of chemotherapy and the reaction the patient had when they were admitted in the hospital. And Dr. Maunglay explained that this nurse who confronted him were, were approached by Dr. Fata's attorneys and Dr. Fata's attorneys had threatened her, threatened her career um, try, just in other words, to stop her from talking about what she discovered, and silenced her essentially.

[00:25:24] Will Johnson: Dr. Maunglay does tell George about a specific drug that Fata was prescribing frequently. George takes that information and goes to someone he knows and trusts, a nurse in the practice.

[00:25:34] George Karache: I explained to her that um, I was made aware of a drug that we used that we may not be giving appropriately. Do you know anything about the drug called IVIG? And she, I remember her, this is very clear in my memory. She went blank. And her face turned like to stone, and she became sorrowful and then began to cry. And she said to me, "Are we in trouble?" And I said, "In trouble? I don't know if we're in trouble or not. I'm not qualified to judge you, but I, I, I really would like to know what, what you discovered." She said, "Well, I found within a week, uh I looked at some of the, the, the uh schedule that Dr. Fata had on patients from consultation, and out of the 40 patients that were scheduled for IVIG, 38 didn't need it. 38 didn't qualify for the drug, 'cause they didn't have the symptoms that were, that uh would warrant using this drug." And uh, "So myself," and she was talking about herself, "and another nurse confronted Dr. Fata with those names of the 38 patients." And she said that Dr. Fata relented and said, "Okay, I won't do this anymore."

[00:26:54] Will Johnson: The other nurse had given her resignation. George wanted to talk to her next.

[00:26:58] George Karache: And I asked her, um, if she was still considering leaving, and she said, "Of course I am." And I said, "Well I just assumed that it was the IVIG issue that, but isn't, but Dr. Fata had, had agreed not to do this anymore, so I guess the problem is solved. I mean if that's the issue." And she said, "No, George, you don't understand. IVIG is just the tip of the iceberg." I realized that not only was this true that I had the proof, but everything, everything I was taught to believe about what we did at Michigan Hematology/Oncology was a lie. In addition to that, the patients didn't know at all what was going on. You know they were sitting, I could see them in the, getting infusions, and I thought to myself, you know, which patients needed chemotherapy? Which ones didn't need chemotherapy? Which ones were going to be harmed today if I didn't do something about it right away? I didn't look at the center any more like a place that people came to be healed. I looked at the center as a burning building.

(MUSIC SEGUE)

[00:28:19] Will Johnson: George Karache now confronts the fact that he might be the only one to stop the burning, to be a whistleblower once again. He knows he has to do something more than just confront Farid Fata. He has to go higher.

[00:28:34] Will Johnson: I'm back with Peggy Pasado. She is retired now, but for many years was with the Department of Justice and the Medicare Fraud Strike Force Team. Walk us through it in a little more detail. How does it work? I mean you basically are charging Medicare for something that a patient doesn't need in some instances?

[00:28:52] Peggy Pasado: Or doesn't get or doesn't receive.

[00:28:54] Will Johnson: And in home healthcare you mentioned, give us an example of what that might be.

[00:28:58] Peggy Pasado: It was situations where the beneficiaries are receiving home health, and they are not eligible for home health. They're, they're not homebound. but they don't know that they're any part of this, so it has to go back to the home health agency that fills out the form, files the claim and says, at that point that uh, and this person needs the service. Sometimes they make up the information that they put on the claim.

[00:29:24] Will Johnson: And what is home health, what could that entail like somebody coming to your house, a nurse to take, to visit you?

[00:29:29] Peggy Pasado: Right, you get a nurse and an aide or sometimes physical therapy, speech therapy. Uh those are the most common.

[00:29:36] Will Johnson: And so in a lot of cases as you've pointed out, there may be people in the middle of all this who have no idea what's going on, but somebody is committing a crime.

[00:29:43] Peggy Pasado: Exactly.

[00:29:44] Will Johnson: The impact on a person and their healthcare coverage if, if Medicare fraud is committed, um, can, can you explain that at all? Is that, are there repercussions there or bad care?

[00:29:54] Peggy Pasado: The problem with it, the effect on it is non-existent. I mean because they don't even know what's going on. And we've never, to my knowledge, we've never done anything to the beneficiaries that were involved. Even when we, in one, with one exception, if I can touch on it a second, but for the most part the beneficiaries, they're these vulnerable victims of these frauds; they didn't, they didn't start it, and they're, they're not part of it.

[00:30:20] Will Johnson: And in some cases, as in the one we're talking about on, on The Perfect Scam, it could be something awful where someone's getting medication or treatment that they don't need, but it could, as you mentioned also, be something where somebody's just not getting something, and maybe they didn't need it in the first place or, I mean there's all sorts, there's...

[00:30:39] Peggy Pasado: I'll give you, I'll give you an example of that. Uh in Miami, when we first started looking at some of the home health cases, I'd gone out and was talking to this woman, and she lived on the third floor. And I was asking her all these questions about being how she managed to do this and that? And she said, "Oh, they told me to do this." I said, "Who told you to do this?" So she proceeded to tell me about this home health agency coming. And I said, "What do they do when they come here?" "They clean my bathroom, they clean my kitchen, they're very nice." Had nothing to do with medical.

[00:31:12] Will Johnson: Right, Peggy, we're, there are so many people out there that I'm sure are appreciative of the fact that you, you do have, you have dug into these numbers. I hope you'll join us next week when we come back and talk more about this uh particular fraud with Dr. Farid Fata. And uh and join us again.

[00:31:28] Peggy Pasado: Sure.

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[00:31:29] Will Johnson: If you, or someone you know, has been the victim of a fraud or scam, call AARP's Fraud Watch Network Helpline, at 877-908-3360. As always, thanks to my team of Scambusters, producers Julie Getz and Brook Ellis, and of course audio engineer Julio Gonzales. Be sure to find us on Apple Podcast or wherever you listen to podcasts. For The Perfect Scam, I'm Will Johnson.

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