Warm Southern Breeze

"… there is no such thing as nothing."

Posts Tagged ‘Medicare’

Ed Henry, Former Alabama Republican State Representative, Pleads Guilty To Medicare Fraud Related To Massive Illegal Narcotics Prescription Operation

Posted by Warm Southern Breeze on Friday, January 11, 2019

Corrupt Alabama Republican Politician Ed Henry Pleads Guilty

Ed Henry was a Republican Alabama State Representative from State House District 9, and misused, and abused the people’s trust, and office for personal, private gain.

Ed Henry has decided to PLEAD GUILTY to Federal charges of Healthcare Fraud involving a Montgomery pill mill – a clinic that dispenses controlled substances wrongfully and unlawfully, for non-medical reasons.

According to the indictment, “The practice was a lucrative business venture. In 2014, the practice earned gross receipts of or about $4,352,352.63. In 2015, the practice earned gross receipts of or about $3,292.549.40. In 2016, the practice earned gross receipts of or about $3,087,530.25.”

Earlier, all other involved parties in that case had plead guilty.

ALL PLEAD GUILTY TO FELONY CHARGES

They include:

1.) Dr. Gilberto Sanchez MD (License surrendered) – age 56, of Cecil, AL; 5 counts; plead guilty to drug distribution conspiracy, health care fraud, and money laundering charges

2.) Dr. Shepherd A Odom MD – (License surrendered) – age 78, of Alexander City; 2 counts; part owner of Family Practice, 4143 Atlanta Highway, Montgomery, AL until 2013 when he sold his interest to partner Dr. Gilberto Sanchez MD, though he continued to remain active, and launder money.

NOTE: Doctors Gilbert Sanchez and Shepherd Odom pleaded guilty prior to indictments in late 2017.

3.) Dr. Julio Delgado MD (ACTIVE License; License restricted) – age 56, of Homewood, AL; 22 counts; felony offense, aiding and abetting acquisition of a controlled substance by subterfuge, violation of Federal and State law

4.) Dr. Willie James Chester MD (License surrendered) – age 64, of Pike Road, AL
5.) Steven Edwin Cox NP (License revoked) – age 61, of Tallassee, AL; charged with 24 counts; pleaded guilty to two felony counts: conspiracy to distribute a controlled substance and health care fraud.

6.) Elizabeth Cronier NP (License revoked) – age 70, of Montgomery; charged with 15 counts
7.) Stephanie Michell Ott RN (License revoked) – age 42, of Fairhope, AL

8.) Misty Michelle Fannin – Administrator – age 41, of Tallassee, AL, money laundering

9.) Farley Pugh – Office Manager – age _?_, of _?_, pleaded guilty to conspiring to make false statements related to health care matters. NOTE: Earlier, in 2010, the AL Supreme Court ruled in a case involving Dr. Sanchez, and noted that Farley Pugh, who was Sanchez’ employee, had forged the signature of one of the parties in the case, Donna McKinney, in a bond-for-title agreement. 2010 Supreme Court of Alabama, Ex Parte Donna McKinney and Marlin McKinney Petition for Writ of Mandamus, in re: Gilberto Sanchez v Donna McKinney & Marlin McKinney (Elmore Circuit Court, CV-09-900268)

10.) Ed Henry – GUILTY

11.) Lillian Akwuba NP (License revoked) – age 38, of Montgomery; 28 counts TOTAL; 14 counts Health care fraud, aiding and abetting; 8 counts Controlled substance – sell, distribute, or dispense; aiding and abetting; Conspiracy to distribute controlled substance; Attempt and conspiracy to commit mail fraud; 2 counts Controlled substance: sell, distribute, or dispense; Money laundering – interstate commerce; Interstate Commerce; aiding and abetting;

12.) Jacqueline Suzanne Brownfield – Billing – age 33, of Wetumpka, healthcare fraud
13.) Akash Kumar – Billing – age 27, of Montgomery, healthcare fraud

Johnnié Sanders, LPC page

14.) Johnnié Chaisson Sanders – Licensed Professional Counselor – (Alabama Board of Examiners in Counseling LICENSE STATUS UNKNOWN) – age 48, of Wetumpka
Her page on the Healing Hearts Counseling website:
https://mentalwellnesscounselor.com/al/montgomery/johnnie-sanders/

License Number: 3130
Name: Johnnié Chaisson Sanders
Address: Healing Hearts Counseling Montgomery, AL 36117
Work Phone: (334) 425-5371
Expire Date: 7/31/2019

NOTE: In 2009, Ms. Sanders had earlier plead guilty to theft, fraud and aiding and abetting fraud charges in USA v Johnnie Chaisson Sanders, Case 2:08-cr-00204-WKW-TFM. USA v Johnnie Chaisson Sanders

Sanders provided bogus diagnoses of mental health conditions for the purpose of allowing Dr. Sanchez to support prescribing unnecessary medications. Sanders also collected cash payments from patients for counseling services even though she knew that Dr. Sanchez’s office would bill the patients’ insurance companies for the same services. On perjury, Sanders testified before a grand jury and falsely claimed that Dr. Sanchez did not require patients to undergo counseling sessions with her. In fact, as Sanders then knew, Dr. Sanchez required patients who received prescriptions for controlled substances to visit Sanders for mental health counseling.

Related News Releases by the Department of Justice, United States Attorney’s Office, Middle District of Alabama:

Tuesday, December 5, 2017
https://www.justice.gov/usao-mdal/pr/one-physician-and-three-nurse-practitioners-charged-participating-operation-montgomery

Monday, December 11, 2017
https://www.justice.gov/usao-mdal/pr/another-montgomery-pill-mill-doctor-pleads-guilty-drug-distribution-and-money

Wednesday, January 24, 2018
https://www.justice.gov/usao-mdal/pr/nurse-practitioner-pleads-guilty-drug-distribution-and-health-care-fraud-charges

Wednesday, January 24, 2018
https://www.justice.gov/usao-mdal/pr/three-clerical-workers-charged-participating-operation-montgomery-pill-mill

Thursday, March 1, 2018
https://www.justice.gov/usao-mdal/pr/another-doctor-and-nurse-indicted-participating-operation-montgomery-pill-mill

Tuesday, May 15, 2018 –
https://www.justice.gov/usao-mdal/pr/physician-nurse-practitioner-and-nurse-plead-guilty-montgomery-pill-mill-case

Wednesday, May 30, 2018
https://www.justice.gov/usao-mdal/pr/mental-health-counselor-indicted-health-care-fraud-and-perjury-offenses-stemming

Dr. Gilberto Sanchez MD, of Montgomery – Family Practice clinic owner – plead guilty in Federal court to healthcare fraud, money laundering, and drug distribution violations, sentenced to 12 years in Federal prison

Dr. Julio Delgado MD, 55 of Homewood

Nurse Practitioner Lillian Akwuba, 38 of Montgomery

Nurse Practitioner Steven Cox, 62 of Tallassee

Nurse Practitioner, Elizabeth Cronier, 69 of Montgomery

Dr. Willie Chester MD, 65 of Pike Road, plead guilty to one count of aiding and abetting the fraudulent acquisition of controlled substances, admitting that he wrote a prescription for clonazepam, commonly known as Klononpin, despite knowing the patient had no legitimate medical need for the medicine.

Delgado and the Nurse Practitioners conspired with Sanchez to unnecessarily and illegitimately prescribe controlled substances to the patients of Family Practice, and committed health care fraud by causing insurance companies to be billed for unnecessary office visits, which only purpose was to refill unnecessary medications, and that Akwuba conspired with Sanchez to launder money.

Ed Henry was charged with one count of conspiring to pay kickbacks and to defraud the U.S., one count of conspiring to commit health care fraud, one count of conspiracy to commit money laundering, five counts of health care fraud and six counts of paying unlawful kickbacks.

Ed Henry owned MyPractice24 which provided non-face-to-face chronic care management services to Medicare beneficiaries with two or more chronic conditions, and contracted with doctors to provided services who would bill Medicare for the services, then pay Henry’s company a share of the reimbursements from Medicare.

Ed Henry entered into an agreement with Dr. Gilberto Sanchez of Montgomery in 2016 in which MyPractice24 provided various kickbacks to Sanchez and his staff in return for referring Medicare beneficiaries to MyPractice24 for chronic care management services.

Ed Henry also assisted Sanchez in paying kickbacks to patients who enrolled in the chronic care management program which were paid by Sanchez by systematically waiving copays that Medicare required Sanchez to collect.

A corrupt Republican and former Alabama State Representative in House District 9 which includes parts of Morgan, Cullman, and Marshall counties, Ed Henry had a habit of saying very stupid things. He was also the state legislator who led the charge to impeach corrupt former Governor Robert Bentley who later resigned under a plea deal with state prosecutors.

Ironically, Henry was absent for most of the 2018 Legislative Session, and attempted to reassure his constituents that his absence was inconsequential by saying that, Read the rest of this entry »

Posted in - Did they REALLY say that?, - Read 'em and weep: The Daily News, WTF | Tagged: , , , , , , , , , , , , , , , , , , | Leave a Comment »

Deep Data Mining & Personal Privacy: The NSA has NOTHING on BIG BUSINESS

Posted by Warm Southern Breeze on Saturday, June 8, 2013

Much ado about nothing.

That’s how I describe the recent ruckus & hullabaloo made about the recent UK news story that “revealed” the U.S. National Security Agency is “spying” on American citizens at home.

The reality is, that the information the NSA is creating is called “metadata,” is a set of data that describes & gives information about other data. Phone numbers called, dates, times & length of calls is NOTHING by comparison to what BIG BUSINESS knows about us already.

Why do you get certain junk mail?

Ever got junk mail from the AARP?

If you’re near age 50, or older, you probably already have.

Ever gotten junk mail from Social Security, Medicare, FDIC, or even your Congressman or Senator?

I dare say you have NEVER.

When you bought your car, if you borrowed money to purchase it, the bank or credit union which loaned the money to you performed a background credit check on you before they loaned their money to you.

Where do you think they got such information? The federal government?

Please… don’t insult my intelligence.

When you applied for a credit card, did you happen to list your age or birthdate on the application?

What about the life, health, auto, or house insurance policies you have? Did you mention your relationship status, number of children, their ages, specifics of your health including medicines, treatments, surgeries, income & source, length of residency, height, weight, or even the size, color & consistency of your last bowel movement?

I would imagine the answer to ALL those questions – at one time or another – has been “yes.”

And yet, unless you’ve served in the Armed Services, or as a Read the rest of this entry »

Posted in - Business... None of yours, - Faith, Religion, Goodness - What is the Soul of a man?, - Politics... that "dirty" little "game" that first begins in the home., - Read 'em and weep: The Daily News | Tagged: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | 5 Comments »

The Theory of Everything

Posted by Warm Southern Breeze on Sunday, October 7, 2012

I’m elated to learn that there is a “Theory of Everything.”

As I delved further into it, I found that Read the rest of this entry »

Posted in - Did they REALLY say that?, - Faith, Religion, Goodness - What is the Soul of a man?, - Lost In Space: TOTALLY Discombobulated, - Politics... that "dirty" little "game" that first begins in the home. | Tagged: , , , , , , , , , , , , , , , , , , , , , , , | Leave a Comment »

Alabama’s Quandary: Nur$ing Homes, or Home Care?

Posted by Warm Southern Breeze on Friday, October 5, 2012

It’s almost like trying to patch a roof while it’s leaking.

October 04, 2012

This Week in Alabama Politics

By Steve Flowers
It is basic public policy that you either have to raise taxes or reduce government services. It has become a cardinal sin in Republican politics to even say the word tax much less enact any increase in revenue. Our legislature is now overwhelmingly Republican and they are real Republicans. They take their no new tax pledge seriously as does our Republican governor. Therefore, when the dicing and crafting of the 2013 budget was being processed, new revenue enhancement measures were not on the table. It is doubtful that you will see any tax increase proposals anytime soon in the Heart of Dixie.

The state’s new budget year begins this week. It will be horrendous. There are draconian cuts to basic state services. Alabama has a constitutional amendment that mandates a balanced budget. We are in dire straits but at least we are not deficit spending like other states. California is teetering on bankruptcy.

This past year’s budget was bad. Teachers and state employees pay was cut this time last year. However, if you think that last year was bad, you ain’t seen nothing yet. This is the year that the chickens have finally come home to roost. The federal stimulus manna from Heaven has provided a lifeline salvation for several years but those dollars are gone. This fiscal year may well be the worst dilemma since the Great Depression.

My contention is that it is worse than the Depression years. During that era the state Read the rest of this entry »

Posted in - Politics... that "dirty" little "game" that first begins in the home. | Tagged: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a Comment »

Led by GOP Speaker of the House John Boehner, Ladies and Gentlemen, introducing your “Do Nothing Congress” of 2012

Posted by Warm Southern Breeze on Tuesday, August 21, 2012

Republican obstructionism, or Republican obstructionism?

So far this year, lawmakers have staged 195 roll-call votes, which boils down to only about 60 pieces of legislation, including post-office namings.

Among them are:
● The Mark Twain Commemorative Coin Act.
● The Sportsmen’s Heritage Act of 2012.
● Legislation requiring the Treasury to mint coins commemorating the 225th anniversary of the U.S. Marshals Service.
● The World War II Memorial Prayer Act.
● The Permanent Electronic Duck Stamp Act.

Because the Democrats lack a filibuster-proof majority in the Senate, they can bring virtually nothing to a vote without the blessing of the Republicans. Even with that hurdle, the Senate has been able to slog through a few bills in recent weeks, including Read the rest of this entry »

Posted in - Uncategorized | Tagged: , , , , , , , , , , , , , , , , , , , , , , , , , , , | 1 Comment »

A Retrospective: Bush & the GOP’s Promises VS Reality

Posted by Warm Southern Breeze on Sunday, August 19, 2012

Does anyone remember this?

Nope. Probably not. That’s why it’s being posted here… to remind us all.

In the first Presidential Debate in 2000 with Vice President Al Gore, Jr. and former Texas governor & GOP candidate George W. Bush, the forum included questions on the topics of budget & economy, governmental reform, healthcare, Social Security, tax reform, education, energy & oil, foreign policy, homeland security, war & peace, and abortion.

As you read the responses below, consider how Read the rest of this entry »

Posted in - Did they REALLY say that?, - Lost In Space: TOTALLY Discombobulated, - Politics... that "dirty" little "game" that first begins in the home. | Tagged: , , , , , , , , , , , , , , , , , , , , , | Leave a Comment »

Paul Ryan Will Save Social Security & Medicare

Posted by Warm Southern Breeze on Sunday, August 19, 2012

NOT!

The original title of this entry was “Paul Ryan Contradicts Himself & Pimps his Mother.

For behold, it’s a case of “The pot calls the kettle ‘black.'”

First, he is a career politician damning “this board of bureaucrats,” of which he is a founding, card-carrying member.

Paul Ryan has never held an honest, private sector job a day in his life (if you count driving the Oscar Meyer Weinermobile during summer in college), and has ONLY had political jobs since he first started working.

He has completely IGNORED the findings of the Congressional Budget Office, the Office of Management and Budget and the Governmental Accountability Office, all who have independently found that the Patient Protection and Affordable Care Act decrease the budget and has NOT taken ANY money from Medicare, Medicaid or the Social Security Trust Fund (SSTF).

You know the saying: Read the rest of this entry »

Posted in - Lost In Space: TOTALLY Discombobulated, - Politics... that "dirty" little "game" that first begins in the home. | Tagged: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a Comment »

Today Mitt Romney spoke out of the _?_ side of his mouth, and said:

Posted by Warm Southern Breeze on Tuesday, August 14, 2012

“And you know what he did with it? He’s used it to pay for Obamacare, a risky, unproven, federal takeover of health care.”Mitt Romney

Government estimates say that more than 6,000 jobs statewide and 20 percent of Iowa‘s electricity needs come from wind power, and the state’s senior GOP leaders all support renewing an extension of a wind tax credit that Romney opposes.

Romney’s campaign did not respond to repeated quests for his position on the other portions of the bill, which includes items such as a tax break for developers of NASCAR facilities and purchasers of electric motorcycles.


http://www.businessweek.com/ap/2012-08-14/gop-ticket-faces-growing-pains-as-dems-attack

FACT: The Congressional Budget Office (CBO) has determined that the Patient Protection and Affordable Care Act is fully paid for, Read the rest of this entry »

Posted in - Politics... that "dirty" little "game" that first begins in the home., - Read 'em and weep: The Daily News | Tagged: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a Comment »

Q: Why do hospitals charge $75 for aspirin? A: Because they can.

Posted by Warm Southern Breeze on Wednesday, May 2, 2012

It was once a long-standing joke that hospitals charged outrageous prices on medicines.

It’s not a joke anymore.

Once, a healthcare joke went like this:
Q: What’s the difference between a HMO, a PPO and the PLO?

A: You can negotiate with the PLO.

It’s not a joke anymore.

It should also be noted that a study conducted 26 years go by Jack D. McCue, Charles Hansen, and Peter Gal entitled “Hospital Charges for Antibiotics” found that:

“Hospital charges for intravenous antibiotics were obtained in a survey of 71 hospitals in 25 U.S. cities. Only 56.3% of the hospitals used their actual drug acquisition cost to calculate patient charges; the remainder used a base price derived from one of the wholesale price guides, which often seriously overstate the cost of antibiotics. Sixty-eight percent added a markup, averaging 134.5%, and 63.4% added a dispensing fee, averaging $5.47. A relatively high-dose, single-antibiotic regimen costs patients $50-$150 per day, independent of dose-preparation charges (average, $9.09 per dose) for a piggyback-type system or intravenous line-related charges. Antibiotics were least expensive in large hospitals and in those located in the northeastern United States. Charges for antibiotics are often inconsistently calculated, vary enormously among hospitals, and may be unfair to patients and confusing to physicians. Cost-conscious prescribing of antibiotics by physicians would be facilitated by a more consistent relationship between charges and true costs.”

That 1985 study may be found here.

The reader should also understand that in a hospital, ALL medications are administered by prescription only… even aspirin.

Cost Spotlight: A 443% Markup on Prescription Drugs

Kaiser Health News/USA Today shines a spotlight on increasing hospital costs specifically the price markup of over-the-counter and prescription drugs hospitals administer to patients.  The story examines Read the rest of this entry »

Posted in - Business... None of yours, - Did they REALLY say that?, - Read 'em and weep: The Daily News | Tagged: , , , , , , , , , , , , , , , , , , , , , , , , , | 1 Comment »

What happens when physician pay is tied to efficiency & quality?

Posted by Warm Southern Breeze on Monday, April 16, 2012

What would it be like if you were paid for your success?

What would it be like if you were rewarded for high efficiency?

Is it possible that successful patient outcomes could be correlated to compensation?

How would one measure non-compliant patients, or those with poor prognoses?

Medicare moves to tie doctors’ pay to quality and cost of care

By Jordan Rau, jrau@kff.org Published: April 14

CMS plans to base the 2015 bonuses or penalties on what happens to a doctor's patients during 2013.

Twenty-thousand physicians in four Midwest states received a glimpse into their financial future last month. Landing in their e-mail inboxes were links to reports from Medicare showing the amount their patients cost on average as well as the quality of the care they provided. The reports also showed how Medicare spending on each doctor’s patients compared with their peers in Kansas, Iowa, Missouri and Nebraska.

The “resource use” reports, which Medicare plans to eventually provide to doctors nationwide, are one of the most visible phases of the government’s effort to figure out how to enact a complex, delicate and little-noticed provision of the 2010 health-care law: paying more to doctors who provide quality care at lower cost to Medicare, and reducing payments to physicians who run up Medicare’s costs without better results.

Making providers routinely pay attention to cost and quality is widely viewed as crucial if the country is going to rein in its health-care spending, which amounts to more than $2.5 trillion a year. It’s also key to keeping Medicare solvent. Efforts have begun to change the way Medicare pays hospitals, doctors and other providers who agree to work together in new alliances known as “accountable care organizations.” This fall, the federal health program for 47 million seniors and disabled people also is adjusting hospital payments based on quality of care, and it plans to take cost into account as early as next year.

But applying these same precepts to doctors is Read the rest of this entry »

Posted in - Did they REALLY say that?, - Read 'em and weep: The Daily News | Tagged: , , , , , , , , , , , , , , , , , | Leave a Comment »

Dirty Diapers and Death

Posted by Warm Southern Breeze on Monday, April 2, 2012

Today, I had remarked to long-time friend that, “I sure hope we get socialized medicine in the United States soon.

I had reflected upon the thousands – literally thousands – of people I’ve seen needlessly stuffed away in Nursing Homes with no family member to love them, and the injuries and emotional insults they suffer as a result.

I continued and said, “The reason most folks send a parent or loved one to a Nursing Home is because Read the rest of this entry »

Posted in - Faith, Religion, Goodness - What is the Soul of a man? | Tagged: , , , , , , , , , , , , , , , , , , | Leave a Comment »

Ending Obamacare

Posted by Warm Southern Breeze on Sunday, January 22, 2012

Among conservatives, there’s little argument that Obamacare should be abolished. ‘It’s time to get government out of our lives,’ they say.

They make many very valid points. Those same folks have expressed concerns that instead, Read the rest of this entry »

Posted in - Did they REALLY say that?, - Faith, Religion, Goodness - What is the Soul of a man? | Tagged: , , , , , , , , , , | 4 Comments »

Conservatives prepare demands for budget talks

Posted by Warm Southern Breeze on Saturday, May 7, 2011

Certainly, there’s little or no disagreement that much change is needed in the way that national politics works. At its heart however, politics is the art of compromise. And politics, first begins in the home – because neither daddy, mama, nor children always get their way; but on occasion, daddy gets his way, mama gets hers, and by mutual consent with mama & daddy, on occasion the children get theirs. Changing the tenor of political operation in this nation begins with a few points, the first of which is that that we all love this nation, and seek the best for the people. One thing I’d like to see – which others have similarly expressed – is Term Limitations in the House and Senate; perhaps five in the House (10 years) and two in the Senate (12 years), for a grand total of 22 years service.

House conservatives prepare strong demands to raise the debt-ceiling

By Erik Wasson – 05/07/11 09:55 AM ET

House conservatives appear comfortable with being unable to get Medicare reform in exchange for the debt ceiling being raised and are coalescing around other strong demands including enactment of a balanced budget amendment.

Tea Party-backed freshmen and the Republican Study Committee are Read the rest of this entry »

Posted in - Uncategorized | Tagged: , , , , , , , , , , , , , , | Leave a Comment »

Healthcare Reform Addresses Rising Health Care Costs

Posted by Warm Southern Breeze on Monday, February 28, 2011

Healthcare reform is going to happen because it has to. We cannot, as a country, continue to absorb cost increases in healthcare.”
– Cullman (AL) Regional Medical Center CEO, Jim Weidner, Thursday, 24 February, 2011 in his “State of the Hospital” address

The CEO’s address was encouraging, not the least reasons of which were that Read the rest of this entry »

Posted in - Uncategorized | Tagged: , , , , , , , , , , , , , , , | 1 Comment »

“Do you have limited income and resources?”

Posted by Warm Southern Breeze on Tuesday, November 17, 2009

So began the paragraph on a document sent to a retiree friend of mine.

The next paragraph read in part, “You may qualify for extra help paying your Medicare prescription costs.”

As I pondered the question it was suddenly obvious that everyone has “limited income and resources,” including Bill Gates and Warren Buffett.

…unless, of course, you’re God.

 

Posted in - Did they REALLY say that? | Tagged: , , , , , , , , , , , , , | Leave a Comment »

 
%d bloggers like this: