The Most Corrupt Company in Oncology

[RadOncG]

Fascinating article this week on the culture of corruption at the largest radiation oncology provider in this country- 21st century radiation oncology.

A Rick Scott story - how political giving and getting is done

Their fraud and anti-kickback settlements are well known. This got much less attention. Essentially they bribed Florida governor Rick Scott to win a no-bid government contract. A whistle blower filed suit. Because 21st century filed for bankruptcy the whisteblower suit was dismissed as dischargeable debt for the company. Massive PR nightmare for 21st century oncology and Rick Scott avoided by a bankruptcy.

Be careful with this company in job searches. Tough to have any association to them.

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[scarbrtj]

I always thought it was weird--maybe good, maybe bad, depends on your capitalistic inclinations--that we were essentially the only specialty in medicine that could singularly give rise to a publicly traded stock and a billion dollar company. Turns out, probably bad: too much room for corruption etc. But you have to hand it to Dosoretz, he's literally made out like a bandit. He's like The Last Guru.

Out of the roughly I'm guessing 5000 radiation oncologists in America, quite a few are employed at 21st Century (10%?). I kinda do feel sorry for them; I bet the vast majority are good folks. The guys at top, though...

 

[deleted947887]

And now one of them is molding the education of the next generation of radiation oncologists.

What an embarassment.

I always thought it was weird--maybe good, maybe bad, depends on your capitalistic inclinations--that we were essentially the only specialty in medicine that could singularly give rise to a publicly traded stock and a billion dollar company. Turns out, probably bad: too much room for corruption etc. But you have to hand it to Dosoretz, he's literally made out like a bandit. He's like The Last Guru.

Out of the roughly I'm guessing 5000 radiation oncologists in America, quite a few are employed at 21st Century (10%?). I kinda do feel sorry for them; I bet the vast majority are good folks. The guys at top, though...

 

[RickyScott]

I compete against them, but in this area, their docs are very good- I have no problem sending them pts who live to far away. (predictably they do little hypofractionation.) I get the sense that when Dosoretz was CEO and had a large equity stake, he pushed limits as described in the article, but he is no longer, and they are being run by lawyers, after being taken over by hedge funds. (they probably will end up being sold to us oncology/mckesson)

However, lets compare them to a large university center with a protons, then who is the bad guy? Is ASTRO corrupt when they protest cuts in reimbursement for protons? Places like MDACC and MSKCC are charging insurance companies 5 times what 21C (and my community hospital) for the same treatment. 21C in my area treats indigent pts, but not our local university/NCI center.
In short, how do you frame Dosoretz's aggressive business tactics in relation to Stanford charging insurances 16,000+ for an MRI or the Mayo clinic charging 60,000+ for stereo to a bone lesion? (mednet) At what point do the prices become outright banditry?

Dosoretz gaining favorable contracts with bribery vs university centers monoplostic pricing power. In the grand scheme, it is the prices of large health care systems that is destroying health care.
Healthcare: It's The Prices, Stupid. Isn't It?

 

[medgator]

And now one of them is molding the education of the next generation of radiation oncologists.

What an embarassment.

And the other person in this story managed to win the governorship, twice and is making a run for Senate.

Disappointing

 

[thecarbonionangle]

The kevin md article was a bit too flacid for my liking. I really think that the fact that the guy who runs our boards is same guy in charge of the most corrupt coorporation in rad onc is a HUGE scandal. Ridiculous that this type of individual was allowed to get there only shows the failure of “leadership” in our field. We deeply need good people leading us or we will Sink.

No way forward than to retire this dinosaur. The level of arrogance and professionalism he showed in his responses to emails really shows he cannot lead us. This is a disaster.

 

[RadOncDoc21]

The kevin md article was a bit too flacid for my liking. I really think that the fact that the guy who runs our boards is same guy in charge of the most corrupt coorporation in rad onc is a HUGE scandal. Ridiculous that this type of individual was allowed to get there only shows the failure of “leadership” in our field. We deeply need good people leading us or we will Sink.

No way forward than to retire this dinosaur. The level of arrogance and professionalism he showed in his responses to emails really shows he cannot lead us. This is a disaster.

Your statements are true but I don’t think the “leaders” care. They are milking this cow as much as they can before they retire or likely die since most really are retired, however still “working.”

 

[RadOncG]

The kevin md article was a bit too flacid for my liking. I really think that the fact that the guy who runs our boards is same guy in charge of the most corrupt coorporation in rad onc is a HUGE scandal. Ridiculous that this type of individual was allowed to get there only shows the failure of “leadership” in our field. We deeply need good people leading us or we will Sink.

No way forward than to retire this dinosaur. The level of arrogance and professionalism he showed in his responses to emails really shows he cannot lead us. This is a disaster.

Agree it is a huge story. His title is- "Senior Vice President of 21st Century Oncology, Inc. In that role he is responsible for legislative and regulatory affairs, organizational, vendor, medical school and medical staff relationships, compliance and quality assurance, research and education, and corporate development."

The person in charge of compliance and legislative/regulatory affairs for a company with a new fraud/corruption scandal every month.

In general I have found with pushing these stories that we have the too many chiefs not enough Indians problem on this forum. Everyone knows what should be done but nobody actually wants to do the work.

 

[RickyScott]

Wallner, who probably is over 80, came from the NCI and was chair at Cooper/UMDNJ where he had a small residency. He was then vice chair at UPENN until a few years ago. His expertise was always billing/compliance and policy, like Bogardus. 21C issues stem from bribery/inducements/business arrangements.

The company was organized in a way that skirts Stark laws. From what I understand, it organizes docs into small entities that will distribute bonuses when that unit profits. Ex: you pair a urologist with a pathologist- the urologist will start ordering expensive tests for bladder cancer screening as he now profits though bonuses when he orders those tests. Same is true for urologist with radiation oncologist. (there are laws about the bonus payouts so legally they are somehow considered not totally quid pro quo, because the bonuses are paid out at certain intervals, but that is just a technicality)

But, again, who is the moral outlier here: A doc at MDACC who delivers 3d conformal hypofract for breast with 30-40K charge to insurers or the 21C doc who delivers 28 fractions + boost of IMRT for 20K.

While the MDACC doc may smugly feel morally superior, the reverse is probably true. Utilization is not as big a problem as prices. Helping MDACC, MSKCC, or local monopolistic university health system price gouge society is somehow morally better than working for 21C?

 

[scarbrtj]

Ex: you pair a urologist with a pathologist- the urologist will start ordering expensive tests for bladder cancer as he now profits though bonuses when he orders a lot of those tests.

Urologist: "After my radiation oncology friend got an IGRT machine, he started doing IGRT on every single patient."
One man's fraud is another man's medical necessity; it can be... subjective.

 

[medgator]

While the MDACC doc may smugly feel morally superior, the reverse is probably true. Utilization is not as big a problem as prices. Helping MDACC, MSKCC, or local monopolistic university health system price gouge society is somehow morally better than working for 21C?

The lesser of two evils. It's been well documented how nosebleed prices can get when big hospital systems consolidate and buy up or force out smaller/independent competitors.

Hard to have much leverage as an insurance company when the hospital hydra with 20 outpatient centers is the only game in town. That's how you get to proton and SABR regimens costing more at the hospital/nci designated center than 9 weeks of prostate imrt/igrt in the community