The Daily Scan

October 31, 2018

Last Updated: 1:00 PM EST

Litigation

  • After a six-day trial in U.S. District Court Northern District of Texas, Celestine “Tony” Okwilagwe, Paul Emordi, Adetutu Etti, and Loveth Isidaehomen, were each convicted of one count of conspiracy to commit health care fraud. In addition, Okwilagwe and Etti were each convicted of two counts of false statement in connection with a health care benefit program. According to evidence presented at trial, Okwilagwe and Emordi owned and operated Elder Care, a Medicare and Medicaid provider in Garland, Texas, when both were previously excluded from participating in any federal health care benefit program. Etti, the administrator of Elder Care, concealed Okwilagwe’s ownership and Okwilagwe and Emordi’s exclusions from Medicare and Medicaid. Etti signed false documents that indicated that no one associated with Elder Care was excluded and that another individual owned Elder Care, the evidence showed.  The evidence further established that Isidaehomen signed bank documents and wrote employee paychecks to conceal the involvement of her husband, Okwilagwe. The defendants also engaged in a scheme to submit false and fraudulent bills to Medicare for services that were not needed, the evidence showed. Evidence at trial demonstrated that Elder Care billed Medicare and Medicaid for over $3.7 million for claim reimbursements to which it was not entitled because Okwilagwe and Emordi were excluded from Medicare. (Justice.gov)

 

  • On Monday, a federal jury convicted nurse practitioner Lilian Ifeoma Akwuba, of Montgomery, Alabama, on 17 counts of unlawfully distributing controlled substances, 4 counts of health care fraud, 1 count of conspiring to distribute controlled substances, and 1 count of conspiring to commit health care fraud. The trial evidence showed that, from 2013 through 2016, Akwuba worked at Family Practice. While working under the practice’s owner, Dr. Gilberto Sanchez, Akwuba issued and caused to be issued unnecessary and illegitimate prescriptions for a variety of controlled substances, including fentanyl, hydrocodone (commonly known as “Norco”), oxycodone (commonly known as “Percocet”), alprazolam (commonly known as “Xanax”), and methadone. Akwuba and Sanchez also required these patients to return approximately every month to obtain their prescriptions. These unnecessary office visits and unlawful prescriptions were ultimately billed to the insurance companies, which paid the claims. In 2016, Akwuba left Family Practice and opened her own practice, Mercy Family Health Care, and many Family Practice’s former patients followed her there. After they did so, Akwuba continued to prescribe the patients the drugs the patients had received at Family Practice. In several instances, she increased the patients’ dosages or switched the patients to more potent narcotics than Sanchez had prescribed. Because Akwuba was a nurse practitioner and not a physician, she was not able to issue prescription refills on Schedule II controlled substances without a physician’s approval. Akwuba skirted this rule by, in many instances, forging physicians’ signatures on prescriptions for controlled substances. Additionally, Akwuba instructed her staff members to falsify medical records, so as to justify billing for office visits at increased rates. For example, trial evidence showed that Akwuba falsely reported performing 10 rectal exams on the same patient during the course of a single year. She also erroneously claimed to have performed a colonoscopy in her family practice office. Following these convictions, Akwuba is facing up to 20 years in prison, substantial fines, and up to 3 years of supervised release. (Justice.gov)

Technology

  • On Monday, October 29, the Deputy Secretary of the Department of Health and Human Services (HHS), Eric Hargan, announced the official dedication of the Health Sector Cybersecurity Coordination Center (HC3) at an official opening ceremony in the Hubert H. Humphrey building. As part of October’s National Cybersecurity Awareness Month, and in coordination with the Administration’s rollout of the National Cyber Strategy, the opening underscores HHS’ commitment to support and improve the health sector’s cybersecurity defenses. This mission is now more important than ever with the healthcare sector reporting over 400 major breaches from 2017 to 2018. The HC3 provides a service to healthcare organizations that enables them to protect their assets and patients. To address these threats to the sector, HHS has developed a “coordination center” in the HC3 to coordinate the activities across the sector and report to DHS threats, profiles, and preventive strategies. The HC3’s role is to work with the sector, including practitioners, organizations, and cybersecurity information sharing organizations to understand the threats it faces, learn "the bad guys’" patterns and trends, and provide information and approaches on how the sector can better defend itself. (HHS.gov)

Private Sector

  • Ochsner Health Network (OHN) recently announced the Ochsner Accountable Care Plan (ACP) through Ochsner Health Network (OHN), to Walmart and Sam’s Club associates working in select facilities in the New Orleans Metro, North Shore and Baton Rouge areas of Louisiana. Available January 1, 2019, OHN is working with Walmart as the organization seeks innovative healthcare solutions to improve quality, patient outcomes and reduce the cost of healthcare services. Under the new ACP, Walmart associates from 41 locations can receive care from over 200 primary care physicians and 1,300 specialists who are a part of OHN in the participating regions. In addition to Ochsner hospitals and clinics, St. Tammany Parish Hospital and Slidell Memorial Hospital, along with their aligned community providers in St. Tammany Quality Network and Ochsner Physician Partners is included. “Walmart and Ochsner Health Network came together with the common goal of reducing healthcare costs, while focusing on improved quality and patient experience,” said David Carmouche, MD, President, Ochsner Health Network. “Walmart associates now have a plan that simplifies copays, coordinates care and provides access to thousands of providers in dozens of locations.” (Oshsner.org)

 

 

 

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