Florida Cancer Specialists: Two Cancer Practices, an Agreement to Stay Apart

The Florida Cancer Specialists antitrust DPA documented a market allocation agreement: in that criminal case, the company admitted to reserving chemotherapy for itself and radiation treatment for a competing oncology group in Southwest Florida. Both practices offered medical and radiation oncology elsewhere in the state. In three counties, they agreed to leave part of the cancer business to each other. An insider who knew the treatment services, hiring decisions or conversations between the practices could explain how that division worked.

Florida Cancer Specialists & Research Institute, an oncology group headquartered in Fort Myers, entered the deferred prosecution agreement on April 30, 2020. Under that agreement in the criminal case, the company admitted that the service allocation ran from about 1999 through at least September 2016. It covered Collier, Lee and Charlotte counties.

How the Oncology Service Allocation Worked

The service allocation of chemotherapy and radiation was the heart of the antitrust agreement: Florida Cancer Specialists kept medical oncology, and the competing practice kept radiation oncology in the affected counties. The company’s admitted statement of facts describes both the agreement and what followed: each practice provided its allocated treatments and refrained from providing the other’s.

That division cut across the way cancer care works. The statement of facts explains that medical oncologists treat cancer with chemotherapy or other medications, while radiation oncologists provide radiation therapy. Different specialists often work together on a treatment plan combining those approaches and surgery.

Florida Cancer Specialists had approximately 100 centers across Florida during the period described in its admission, offering both medical and radiation oncology. The competing practice also offered both services elsewhere in the state. The local absence of one service from each practice was something they had agreed to maintain.

The Justice Department’s announcement of the company’s admission said the conspiracy allowed Florida Cancer Specialists to operate with minimal competition and limited integrated care options and choices for patients. Cancer patients lost choices because practices that offered both kinds of oncology elsewhere had agreed to divide them here.

The Hiring Agreement Behind the Treatment Boundary

The government’s criminal information alleged that the service allocation extended to the specialists each practice would employ. Florida Cancer Specialists would not employ radiation oncologists in Southwest Florida, and the other practice would not employ medical oncologists there. Hiring the specialists needed to compete was itself part of the alleged agreement.

The criminal charging document also alleged conversations to maintain the arrangement, work together to prevent competition from unaffiliated oncology providers, and monitor and enforce compliance with the service split. Other providers trying to enter the market faced an alleged effort by the established practices to keep them out.

The charge described decisions reaching down to particular treatments:

That is how an agreement to stay apart can reach everyday operations. According to the charge, the companies discussed who should provide a treatment, who could employ the specialists and how to keep the arrangement in place. A person involved in those discussions could explain why a treatment or a hire was steered to the other practice.

The VDA OC plea supplies a labor-market comparison involving nurses and wages, distinct from the oncology-service allocation here.

Florida Cancer Specialists DPA Employee Noncompete Waiver

The employee noncompete waiver opened a path for current and former personnel to join or start competing oncology practices in Southwest Florida during the agreement’s term. The agreement set that term from April 30, 2020 through December 31, 2023, subject to extension.

Under paragraph ten, Florida Cancer Specialists agreed to waive and not enforce noncompete, nonsolicitation and noninterference provisions restricting competition in oncology services or recruitment of its employees. The clause covered current and former partners, officers, employees and agents, among others, who joined or opened an oncology practice in the affected area during the term.

The waiver addressed both sides of building a competing practice: providing oncology services and recruiting the people to provide them.

The agreement also required Florida Cancer Specialists to email its current personnel a copy of the agreement and a cover letter drawing attention to the waiver. The attached letter named Collier, Lee and Charlotte counties.

The Physician Executive’s Guilty Plea

The former president and managing partner separately admitted his role in the allocation conspiracy through a guilty plea. The Justice Department’s August 24, 2023 announcement reported that the medical oncologist pleaded guilty to conspiring to allocate oncology treatments.

The department described his participation from 1999 through September 2016 in the same three counties, with chemotherapy assigned to Florida Cancer Specialists and radiation assigned to the other company. The company’s earlier admitted statement of facts had already described participation by its former president and managing physician, along with other personnel.

The corporate admission and the executive’s plea put leadership inside the arrangement. For an insider, the relevant decisions include who agreed to the service split and who kept it operating inside the practice.

The Treatment Business Behind the Agreement

In its admitted statement of facts, Florida Cancer Specialists put its revenue from oncology treatments affected by the conspiracy at more than $950 million. That business came from cancer treatment in a market where the two practices had agreed which services each would withhold.

The same statement describes patients relying on private or public health insurance to pay for oncology treatment. The criminal information alleged that the practices submitted payment requests and accepted payments from insurers and patients for treatments provided under the allocation agreement. It specifically identified federal and state insurance plans as well as private insurers among the payers.

The service decisions and the money therefore meet in the treatment business: what each practice agreed to provide, which specialists it employed, and which treatments it billed. For someone working in oncology operations or billing, knowing how those decisions connected may explain a division of business that a patient would only experience as a missing choice.

What an Oncology Insider Can Explain

An oncology insider may know how an agreement between competing practices became a hiring decision, a treatment restriction or an instruction about another provider. The criminal information describes conversations at each of those points. The company’s admission connects the discussions to the services the practices actually provided and withheld.

An employee who knows why a practice declined to offer radiation may hold a different part of the story from a manager who heard discussions about a competitor’s hiring. Someone at an independent practice may know how the established providers responded to its attempt to enter the market. Those perspectives matter because they can connect the missing competitive choice to the people who agreed to remove it.

Our whistleblower experts connect the oncology-service agreement with the treatment and staffing decisions that implemented it. In an oncology matter, that means understanding the treatment services and the staffing decisions together, then identifying where the communications and business records support that account.

Can You Get Paid for Whistle Blowing?

A comparable case could support a reward under the antitrust whistleblower program. We assess whether your information could qualify and work with you on the strongest way to pursue it.

For someone who also knows about false claims paid by a government health program, the False Claims Act raises a separate opportunity. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. We examine the government payment evidence alongside the agreement between competitors to determine which case the facts support.

You Know Why the Practices Stayed Apart

Explain the oncology-service boundary to our whistleblower experts, including the staffing and treatment decisions used to maintain it.