'Long-Running' Conspiracy: Cancer Center's Ex-Top Doc Indicted

William Harwin, MD, founder and former president of Florida Cancer Specialists, a large multisite practice, has been indicted by a federal grand jury for conspiring to restrict patient choice and allocate medical and radiation oncology treatment in southwest Florida, according to the US Department of Justice (DOJ).

"It is unconscionable for a doctor to prioritize profits over patient care," said Michael McPherson, special agent in charge of the Federal Bureau of Investigation (FBI) Tampa Field Office in a press statement about Harwin's indictment.

The indictment comes about 5 months after Florida Cancer Specialists was charged with criminal antitrust conspiracy, which is a felony, and agreed to pay a penalty of $100 million, as reported by Medscape Medical News.

Harwin, as an individual, is now being charged with having allegedly participated in this same criminal conspiracy, which the DOJ described as "long-running."

Last week, Harwin responded to the indictment. "Let me be absolutely clear about this — I am innocent of the charges that have been brought against me and will fight with everything I have to clear the good name that I have worked so hard for during my entire career," he said in a statement, reported by the News-Press, a Florida newspaper.

For nearly 20 years, Florida Cancer Specialists, headquartered in Fort Myers, had an anticompetitive, "illegal agreement" to divide up cancer treatment services with another provider in Collier, Lee, and Charlotte counties, says the DOJ. The deal sent patients needing chemotherapy treatments to Florida Cancer Specialists, and those needing radiotherapy to the other, unnamed oncology group.

However, a large US law firm and a whistleblower lawsuit reported by Medscape Medical News in 2017 both identified the other provider as 21st Century Oncology, one of the largest radiation oncology practices in the United States. That organization, also headquartered in Fort Myers and for many years led by its founder Daniel Dosoretz, MD, has had its own set of financial and legal problems in recent years.

The conspiracy allowed these two oncology providers to operate with "minimal competition," said the DOJ.

Florida Cancer Specialists' revenues totaled nearly $1 billion for treatments delivered by way of the illegal deal, which ran from as early as 1999 until at least 2016, the DOJ said earlier this year.

The charge levelled at Harwin in the indictment, which is not a conviction and only alleges a crime has been committed, carries a maximum penalty of 10 years in prison and a $1 million fine for individuals.

However, the DOJ added that the maximum fine might be increased to twice the gain derived from the crime or twice the loss suffered by victims if either amount is greater than $1 million. In other words, the fine may potentially be much higher.

The Harwin indictment is part of an ongoing DOJ and FBI antitrust investigation into market allocation and other anticompetitive conduct in the oncology industry.

Florida Cancer Specialists Keeps Receiving Federal Dollars

In May, only about 1 month after Florida Cancer Specialists agreed to pay $100 million to the federal government for their felony anti-competitive conspiracy, the large medical oncology practice was back in the news: It had received $67 million in COVID-19 financial aid from the federal CARES Act, as reported by the Tampa Bay Times and multiple other news outlets.

The medical oncology group pledged that coronavirus relief dollars from taxpayers would not be used to pay back their fines.

Also, the DOJ allowed Florida Cancer Specialists to avoid a criminal conviction by ultimately handling the resolution of the conspiracy case via a "deferred prosecution agreement."

A criminal conviction, which could have been brought on the basis of the main charge, would have disallowed Florida Cancer Specialists' participation in federal healthcare programs. Thus a criminal conviction would have barred the group from Medicare payments as well as federally funded clinical trials.

Instead, the organization can 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 Florida Cancer Specialists.

In April, Lucio Gordan, MD, president, Florida Cancer Specialists, told the Wall Street Journal that change has occurred at the organization: "Shortly after learning about this [conspiracy] issue, FCS brought on new leaders, materially enhanced its employee training, and bolstered its compliance program."

Nick Mulcahy is an award-winning senior journalist for Medscape. He previously freelanced for HealthDay and MedPageToday and had bylines in WashingtonPost.com, MSNBC, and Yahoo. Email: nmulcahy@medscape.net and on Twitter: @MulcahyNick.

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