Florida Cancer Center to Pay $100 Million for Criminal Conspiracy

Practice Can Still Receive Federal Dollars

Nick Mulcahy

May 04, 2020

Florida Cancer Specialists (FCS) & Research Institute, one of the largest oncology and hematology service providers in the state, has been charged with criminal antitrust conspiracy and will pay a penalty of $100 million.

For nearly 20 years, FCS, headquartered in Fort Myers, had an anticompetitive, "illegal agreement" to divide up cancer treatment services with another provider in Collier, Lee, and Charlotte counties in southwest Florida, says the US Department of Justice (DoJ). The deal allocated chemotherapy treatments to FCS, and radiotherapy to the other, unnamed oncology group.

FCS revenues totaled nearly $1 billion for treatments delivered by way of the illegal deal, said the DoJ.

The arrangement "allowed FCS to operate with minimal competition in Southwest Florida," from as early as 1999 until at least 2016, according to the DoJ.

"For almost two decades, FCS and its co-conspirators agreed to cheat by limiting treatment options available to cancer patients in order to line their pockets," said Makan Delrahim, assistant attorney general of the DoJ's Antitrust Division, in a press statement.

FCS has also agreed to pay the state $20 million to settle a related civil antitrust investigation, the state attorney general announced last week. Notably, the state cited four oncology practices as co-conspirators in its complaint, not just one as in the federal case.

However, FCS will not be barred from participating in (and being reimbursed by) federal healthcare programs, such as clinical trials, which would otherwise be a possibility with a crime of this type.

FCS has approximately 100 offices and more than 200 doctors statewide, and is among the largest oncology and hematology medical practices in Florida, according to the Florida Attorney General's office.

This is not FCS's first legal dispute regarding anticompetitive business practice in Florida.

Last year, the company settled with Mid Florida Cancer Centers for an undisclosed amount (but did not admit any wrongdoing) about another market dispute in Florida, according to the Orlando Sentinel.

In that case, Mid Florida Cancer Centers alleged that AdventHealth, an oncology provider and hospital owner, struck an exclusive agreement with Florida Cancer Specialists to "not compete with each other in Volusia and Flagler counties; to create a referral loop that excluded Mid Florida; and to stop giving hospital privileges to new doctors hired by Mid Florida."

FCS Avoids Paying Another Price

The DoJ ultimately handled the resolution of the case against FCS via a "deferred prosecution agreement." That avoids a criminal conviction and allows FCS to continue to participate in federal healthcare programs. It also allows patients to continue participating in ongoing, federally funded clinical trials at FCS.

FCS can also continue its involvement with, for example, the Oncology Care Model (OCM), an experimental Medicare payment and services arrangement that financially rewards efficient care. The model is limited to about 200 clinical practices in the United States, including FCS.

Lucio Gordan, MD, president of FCS, said in a reported statement that change has occurred at the organization: "Shortly after learning about this issue, FCS brought on new leaders, materially enhanced its employee training, and bolstered its compliance program."

FCS has ties to prestigious oncology organizations. It is a recipient of the American Society of Clinical Oncology's national Clinical Trials Participation Award. "CTPA recipients have shown the dedication and committed the resources to develop high-quality clinical research programs in the community setting," ASCO President Richard Schilsky has said.

FCS is also one of five "strategic sites" of the Sarah Cannon Research Institute, based in Nashville, Tennessee, which enrolls patients in hundreds of oncology trials, including many immunotherapy studies. FCS states on its website that, in the past 4 years, "the majority of new cancer drugs approved for use in the US were studied in clinical trials with Florida Cancer Specialists participation."

FCS claims that it delivers "quality and value through patient-centered, coordinated care" and is the only community oncology practice in Florida that is a Blue Distinction Center for Cancer Care, a designation from Florida Blue, a Blue Cross and Blue Shield Association member.

The federal charge against FCS is part of an ongoing investigation into anticompetitive conduct in the oncology industry in Florida, being undertaken by the DoJ's Antitrust Division and the FBI's Tampa Field Office.

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