“This defendant blatantly violated the trust bestowed upon him by the Our Lady of the Lake Foundation and people they serve by stealing valuable resources from those who needed it most"

U.S. Attorney Brandon J. Fremin.

"This conviction and sentence should serve as a warning to those who would betray such trust.
We are pleased that justice has prevailed.”
Funes will turn himself in to prison in early December.

BATONROUGE, La. (WAFB) - A judge sentenced Former Our Lady of the Lake fundraiser John Paul Funes to 33 months in prison Thursday (Oct. 24). He will also have to pay a $50,000 fine.
Standing with a shaking voice in front of Judge John deGravelles, Funes apologized to former colleagues at the hospital he once worked for, to his family, and to the victims.
"The crimes and sins I committed were a result of weakness," Funes said. "I lived a culture of lies."
Funes is convicted of stealing nearly $800,000 from the Our Lady of the Lake Foundation for personal use. The foundation raises money for Our Lady of the Lake Regional Medical Center and its affiliate hospitals.
He has repaid the $800,000 to the hospital, and will pay the $50,000 fine to the U.S. Government.
Funes made his first court appearance Wednesday, June 12, in which he waived his right to a grand jury indictment and a preliminary hearing. He pleaded guilty to federal charges of wire fraud and money laundering Thursday, June 20.
Prosecutors say Funes, 49, flew family and friends to LSU and New Orleans Saints football games under the guise of “outbound patient transports,” and labeled gift cards he purchased for himself as gifts for cancer patients in order to balance the hospital’s books.
Funes said he prays for the victims of his crimes every day and described his crimes as “awful and senseless.”
“The pain, regret, and remorse I feel is almost as hard to process as the crimes,” he said.
For a similar, first-time white-collar criminal, the federal government typically recommends sentences of 33 to 41 months in jail, accompanied by $15,000-$500,000 fines. Green asked the judge to sentence Funes to just a year-long prison term.
Funes says he’s spent an hour each week in therapy for the past 11 months and saw a counselor as recently as the day before his sentencing.
"I will spend the rest of my life showing these family members who I really am," Funes said.
"These wounds were self-inflicted," Funes' lawyer, Walt Green said.
Green says Funes sought out parents of cancer patients on his own to apologize to them. Two of those parents wrote deGravelles letters in support of Funes.
"This is the most difficult sentencing I've had in all my years on the bench," Degravelles said.
“This was done over and over and over again over a period of six years," the judge said. “This was not a case of Robin Hood.”
Two former LSU football players, Vadal Alexander and Rohan Davey, have found themselves indirectly tied up in the Funes saga.
Funes hired Alexander’s father to do chores, including cutting grass and cleaning up after events, two sources familiar with the case told WAFB in June. But the father soon grew tired of the job and quit, the sources say. The payments, which totaled nearly $180,000, continued even after he quit, sources said.
The money received by James Alexander from Funes was transferred while his son was still on the LSU football team, the sources say.
Funes also sent checks totaling around $107,000 to the mother and sister of former LSU football player Rohan Davey. The pair ultimately funneled back about $63,000 of the money to Funes, sources said.
Davey was not an LSU player when Funes made payments to his relatives. In court, federal prosecutors made reference to the Davey family as ‘victims’ who were sucked into Funes’s scheme.
“I can’t comment on any NCAA investigation or whether there is one or not,” Green said in an interview with WAFB. He would not say whether he or Funes has been contacted by NCAA representatives.
“This defendant blatantly violated the trust bestowed upon him by the Our Lady of the Lake Foundation and people they serve by stealing valuable resources from those who needed it most," said U.S. Attorney Brandon J. Fremin. "This conviction and sentence should serve as a warning to those who would betray such trust. We are pleased that justice has prevailed.”
Funes will turn himself in to prison in early December. He could be released a few months early on good time.

RECENT DENIAL OF TREATMENT

BY PRIMARY CARE PHYSICIAN, J. MICHAEL ROBINSON, DURING CONTRACTION OF COVID-19 SELF-QUARANTINE, WHEREBY a PHYSICIAN FROM SAME FMOLHS OLOL, PHYSICIAN GROUP, DID INITIALLY, UNDER PROTEST, AGREE TO PROVIDE 1 EMERGENCY PRESCRIPTION TO AVOID SERIOUS COMPLICATIONS OF WITHDRAWAL;

COVID SYMPTOMS, DIAGNOSED CELLULITIS HE LEFT UNTREATED, DANGEROUSLY IGNORING INFECTION OF BOTH LEGS.

HAVING RESPONDED TEMPORARILY TO ER COURSE OF ANTIBIOTICS, THEN SECOND COURSE, BEGRUDGINGLY PRESCRIBED BY ROBINSON, WHOSE INITIAL, CURSORY, NO-TOUCH, VISUAL ONLY, IN-OFFICE EXAMINATION, RENDERED THE BAD NEWS TO THE OLOL ER SPECIALIST AND TWO OTHER PHYSICIANS:

WHO HAD DIAGNOSED CELLULITIS, WAS WRONG--BUT HE WOULD PRESCRIBE ONE COURSE OF ANTIBIOTICS, ANYWAY--NO BLOOD TEST, NO OINTMENT--AND IN HIS ESTIMATION, HE COULD DO NOTHING FOR THE PRESENT CONDITION; HOWEVER, HIS TREATMENT PLAN CONSISTED OF ME SELF-REFERRING MYSELF TO A CARDIOLOGIST, IN WHAT MUST HAVE SEEMED TO HIM AS THE MOST EFFICACIOUS MANNER IN WHICH I COULD LEAVE HIS CLINIC OFFICE--QUICKER THAN HIS KNOWLEDGE OF ALL MEDICAL THINGS MIGHT LAST.

I SHOULD MAKE AN APPOINTMENT WITH MY CARDIOLOGIST (FOR THE ALREADY DIAGNOSED STAPH INFECTION OF MY LEGS), ADDITIONALLY, INFORMING ME OF HIS DECISION AFTER AN INITIAL, PARTIAL PRESCRIPTION FOR TRAMADOL, AFTER IN-CLINIC X-RAY AND DIAGNOSIS OF FRACTURE OF L1 AND L2 VERTEBRAL DISCS, WHICH HAD BEEN UNTREATED BUT FOR INITIAL OLOL ER--WHERE HAVING BEEN SEEN BY A RESIDENT WHOSE DECISION NOT TO ORDER AN X-RAY WOULD BE VOLUBLY PROTESTED, AND FINALLY LEAD TO THE AGONIZING WEEK OF HIS FAILURE TO TREAT--FUNNY, WHEN YOU KNOW THAT I ARRIVED BY AMBULANCE, UNABLE TO STAND, ON A GURNEY--SUBSEQUENTLY DISCHARGED BY THE INEPT RESIDENT WITH NO APPARENT SUPERVISION THIS DAY, WITH A PRESCRIPTION FOR acetaminophen 800--WHICH SAW ME SUFFER AS I LAY IN BED FOR THE NEXT WEEK, UNTIL THE PAIN WAS SO SEVERE, THAT I RETURNED (SOMETHING I THINK, FMOLHS IS KNOWN FOR), WHERE AFTER RELATING THE COMPLETE DERELICTION OF PROPER EXAMINATION OR CARE, THE ATTENDING ER DOCTOR, UPON CHECKING MY CHART, ORDERED IMMEDIATE X-RAY AND IV PAIN MEDICATION, APOLOGIZED, AFTER DELIVERING X-RAY RESULT OF COMPLETE FRACTURE OF L1 AND L2--SENDING ME HOME WITH PRESCRIPTION OF ANALGESIC --

CURRENT DOCTOR ROBINSON, NOT ONLY REFUSING TO PRESCRIBE ANY OF THE SAME MEDICATION AS I HAD JUST RECEIVED IN THE ER RUN BY THE SAME INSTITUTION AS WAS HIS PHYSICIAN GROUP CLINIC, BUT INSTEAD, AFTER RELENTING ON FIRST VISIT TO PRESCRIBE TRAMADOL, ON FOLLOW-UP CHANGING HIS MIND.

SAYING ABOUT TRAMADOL: HE WAS SORRY HE COULDN'T CONTINUE TO PRESCRIBE NARCOTIC ANALGESIC SCHEDULED PAIN MEDICINE--BUT, HE CONTINUED PLAINLY: HE WAS AFRAID OF GETTING IN TROUBLE WITH THE DEA (FOR INTRACTABLE, INTOLERABLE PAIN), ERRING ON THE SIDE OF APPREHENSION AND INCOMPETENCE TO TREAT A PERSONALLY DIAGNOSED PATIENT (HE IS A SPORTS DOCTOR), WITH PAIN PROTOCOL--HE WOULD ALLOW HIMSELF TO WRITE ONLY ONE PRESCRIPTION FOR TRAMADOL--THEN, HE WOULD NOT CONTINUE TO PRESCRIBE EVEN TRAMADOL, INFORMING ME:

I SHOULD LOOK FOR A PAIN CLINIC AS SOON AS I COULD (HE ALSO REFUSED TO REFER A PAIN MANAGEMENT PHYSICIAN), WHICH SAW ME LEAVE HIS OFFICE WITH NO TREATMENT, BUT TWO REFERRALS FOR TREATMENT IF I COULD FIND AND MAKE APPOINTMENTS WITH UNKNOWN PHYSICIANS (CARDIOLOGIST FOR CELLULITIS, PAIN MANAGEMENT FOR L1, L2), COMPLETELY UP TO ME (PRESUMABLY, HE HOPED THEY WOULD DO HIS JOB, WHICH HE WAS NOW PASSING DOWN THE LINE IN ABROGATION OF MEDICAL ETHICS AND MEDICAID CMS POLICIES)--AND GOOD LUCK--SO GREAT WAS HIS APPREHENSION AT PERFORMING WITH COMPETENCE HIS JOB, HE THEN LITERALLY JUMPED UP FROM HIS CHAIR IN IMMEDIATE ESCAPE--NEVER TO BE SEEN OR HEARD FROM BY ME AGAIN.
REASONS TO REASSESS PATIENT TERMINATION

EXCEPT AS LAST RESORT

COVID-19 PANDEMIC UPDATE POLICY FOR FEDERAL HEALTHCARE PROVIDERS AND INSTITUTIONS WHO RECEIVE REIMBURSEMENT THROUGH US GOV AFFORDABLE CARE / CMS MEDICAID INSURANCE BEST PRACTICE

REGARDING TERMINATION OF PATIENT FROM PRACTICE: DURING PANDEMIC, SHORTAGE OF DOCTORS, ALLOWANCE SHOULD BE CONSIDERED FOR PLACEMENT WITH ANOTHER DOCTOR OF ASSOCIATED PRACTICE FOR CONTINUITY OF CARE.
ALLOWANCE FOR TELEVISIT APPOINTMENTS

PROVIDING AT-RISK PATIENTS WITH RELAXED PRESCRIPTIONS

MAJORITY OF THOSE PHYSICIANS WHO, HAD THEY HAD TO DISMISS ONE OF THEIR PATIENTS FROM THEIR PRACTICE BEFORE THE PANDEMIC BEGAN (1 OF 4 PHYSICIANS POLLED HAD MADE LAST RESORT DECISION, AFTER TALKING TO PATIENT ABOUT PROBLEM, MEDIATION, FINALLY, UPON PATIENT REFUSING TO MODIFY BEHAVIOR, WHETHER NON-PAYMENT OR MORE SPECIFIC ABUSIVE, VIOLENT OUTBURST, OR THREAT OF VIOLENCE ... WHATEVER REASON--ONE TIME IN THEIR CAREER

pharma access of diagnosed and prescribed continuity, SEE AMA APA Physician's Code of Medical Ethics, termination of patient from doctor, entire clinic practice; depriving patient communication before / after notice by office manager, refusal to provide explanation 5-year medical treatment by Lake Physician's Group Outpatient Clinic, Associate Physician Mark Zielinski, M.D., FMOLHS OLOL Physician Group O'Donovan, Baton Rouge, LA
Assistant Professor, LSU-NO Baton Rouge, Health Science, Resident Program Supervisor
70808 (225) 765-5500 Monday - Friday: 7:00 AM - 12:00 AM Saturday and Sunday: 8:00 AM - 12:00 AM

this is John PaulSongs With the Mascari

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Our Lady of the Lake
TO SCHEDULE VISIT 225-765-5500 on-line MyChart In-Person Video visits performed by board-certified #fmolhs Franciscan Missionaries of Our Lady Health System providers. schedule appointment new (225) 765-5500 *existing patient

*unless, like me, you are being denied consumer services through, but not limited to:

1. Administrative locking of patient records (made inaccessible to all operators, patient, administrative personnel, rendering no access or information, and notations.

2. Universal FMOLHS OLOL-RMC No Contact Order Notation and Legal Counsel Directive, per Ms. Bollinger, Mr. Vrath MD. Denying any and all Services offered and prohibiting inquiries and Emergency medical attention from General Physician, and all Executive Directors and their representatives.

3. Illegally Removed Patient Access to non-FMOLHS, non-OLOL, non-Physician Group, Online Patient Account (MyChart is a third-party website).

Removing critical medical record access HIPPA-protected Medical Information Treatment, Timeline for Entire Provider History, Pharmaceutical, Archive (preventing patient from providing information to any medical provider as to specific medications, treatment, test results, Physician names).

AND PREVENTING ACCESS IN COMBINATION WITH BAN ON CONTACT EMPLOYEES, EXECUTIVES, PHYSICIANS, NURSES, OR ADMINISTRATIVE AGENTS--INCLUDING, RESTRICTING RIGHT TO DUE PROCESS AND APPEAL

Abandonment of Treatment through Retaliative Termination, Malfeasance, precluding visit, denying referral for continuity of care during reduction of healthcare services, failing to provide basic 30-day prescriptions for medications.

Zielinski cherrypicked 1 medication, which he later refilled--once--medication prohibited of immediate cessation; side-effects described as severe agitation, sleep deprivation, anxiety, and seizures from withdrawals--a medication he prescribed, which had previously been prescribed by other physicians at Tulane, Cleveland Clinic, and Las Vegas Medical Center Primary Care providers, now withheld in further retaliation during continuing PHE, this January 2022--egregious and gross violation June of 2021-- CMS proclamation actuated for all Medicaid beneficiaries, March, 2020 -- malfeasance meeting standard of malpractice by State Medical Examiners responsible for Licensure.

Deactivation of Personal Patient Medical Account, against State, Federal CMS, AMA, HHS;

Manipulation of Protected Confidential, Private Account (MyChart), further hindering Patient Request of Access to Due Process and Appeal, as well as Institutional Denial of Grievance, and report of malicious retaliation through all, but not limited, fraudulent charges
RETALIATORY PATIENT ABANDONMENT (THROUGH FRAUDULENT FALSE REPORT)
SEVERING OF PATIENT/PHYSICIAN/CLINIC JUNE 2, 2021
FMOLHS REFUSAL TO COMMUNICATE by TELEPHONE, ELECTRONIC MAIL, OFFICIAL SOCIAL MEDIA ACCOUNTS

dis-enrolled,

2.5.1.9 The Contractor shall provide a mechanism to reduce inappropriate and duplicative use of healthcare services, including but not limited to potentially preventable hospital emergency departments visits and inpatient readmissions

PART 2: CONTRACTOR RESPONSIBILITIES

Compliance

2.1.1 The Contractor shall comply, to the satisfaction of LDH, with: (1) all requirements set forth

in this Contract; (2) all provisions of state and federal laws, regulations, rules, the State Plan,

and waivers applicable to managed care; and (3) the MCO Manual.

2.1.2 The Contractor shall comply with federal statutes and regulations governing managed care, including, but not limited to, all applicable provisions of

42 U.S.C. § 1396u-2 and 42 C.F.R. Part 438 during the term of this Contract. 2.1.3 The Contractor shall cooperate with LDH, CMS, the External Quality Review Organization, the University of Louisiana at Monroe’s Office of Outcomes Research and Evaluation, and any other LDH contractors related to the evaluation and monitoring of this Contract, the Contractor, or the Louisiana Medicaid managed care program.

2.1.4 Neither the Contractor nor any material subcontractor shall, for the duration of the Contract, have any interest that will conflict, as determined by LDH, with the performance of services under the Contract, or that may be otherwise anti-competitive. Without limiting the generality of the foregoing, LDH requires that neither the Contractor nor any material subcontractor have any financial, legal, contractual or other business interest in any entity performing MCO enrollment functions for LDH, the enrollment broker and subcontractor(s), if any.

2.1.5 The Contractor shall comply with all court-ordered requirements, including but not limited to, United States v. State of Louisiana (DOJ Agreement- Case-3:18-cv-00608) and Chisholm v. Gee (Case 2:97-cv-03274) in the manner determined by LDH.

2.1.6 The Contractor shall establish and maintain interdepartmental structures and processes to support the operation and management of this Contract in a manner that fosters integration of physical and behavioral health service provision. The provision of all services shall be based on prevailing clinical knowledge and the study of data on the efficacy of treatment, when such data is available. 2.1.7 The Contractor shall notify LDH in writing when there has been a significant change in its operations. The written notification shall include the details of the change and an assurance that it will not impact the ability of the Contractor to comply with the requirements of this Contract. 2.1.8 The Contractor shall comply with all of the reporting requirements established by this Contract and in accordance with the MCO Manual.

The Chief Executive Officer (CEO) shall provide overall direction for this Contract, develop strategies, formulate policies, and oversee operations to ensure goals are met. The CEO shall be a full-time position (minimum forty (40) hours weekly) based in Louisiana. The CEO shall serve exclusively in this position and may not function in an executive capacity for another insurance product. The CEO shall be the primary contact for LDH regarding all issues and shall coordinate with other key personnel to fulfill the requirements of the Contract. The CEO shall attend all CEO designated meetings in person. 2.3.3.2 The Chief Operating Officer (COO) shall manage day-to-day operations of multiple levels of staff and multiple functions/departments across the MCO to meet the performance requirements of the Contract. The COO shall be accountable to the CEO for operational results and may be designated to serve as the primary point-of- contact for all MCO operational issues. The COO shall be a full-time position (minimum forty (40) hours weekly) based in Louisiana. The COO may not function in an executive capacity for another insurance product. The COO shall attend meetings in person, when requested. 2.3.3.3 The Medical Director/Chief Medical Officer (CMO) shall be a physician with a current, unencumbered license through the Louisiana State Board of Medical Examiners. The Medical Director shall have at least three (3) years of training in a medical specialty and five (5) years of experience post-training providing clinical services. The physician shall have achieved board certification in his or her specialty. The Medical Director shall be located in Louisiana and shall be involved in all major clinical and quality management components of the MCO’s activities. The Medical Director shall be devoted full-time (minimum forty (40) hours weekly) to the Contractor’s operations and shall be responsible for ensuring timely medical decisions, including after-hours consultation, as needed. During periods when the Medical Director is not available, the Contractor shall have physician staff available to provide competent medical direction. The Medical Director shall serve exclusively in this position and may not function in an executive capacity for another insurance product. The Medical Director shall be responsible for: 2.3.3.3.1 Development, implementation and medical interpretation of clinical policies and procedures, including, but not limited to, service authorization, claims review, discharge planning, credentialing and referral management, Page 50 of 347 utilization management and medical review included in the MCO Grievance System; 2.3.3.3.2 Administration of all medical management activities of the MCO; 2.3.3.3.3 Coordinating with the Behavioral Health Medical Director to integrate the 2.3.3.3.4 Serving as member of and participating in every meeting of the Medicaid Quality Committee in person. The Medical Director may designate a representative with a working understanding of the clinical and quality issues impacting Medicaid; and 2.3.3.3.5 Serving as the chairman of the Utilization Management committee and chairman or co-chairman of the Quality Assessment and Performance Improvement committee. 2.3.3.4 The Behavioral Health Medical Director shall be a physician with a current, unencumbered Louisiana-license as a physician, board-certified in psychiatry with at least three (3) years of training in a medical specialty. The Behavioral Health Medical Director shall be devoted full-time (minimum forty (40) hours weekly) to the Contractor’s operations to ensure timely medical decisions, including after-hours consultation, as needed. During periods when the Behavioral Health Medical Director is not available, the Contractor shall have physician staff available to provide competent medical direction. The Behavioral Health Medical Director shall serve exclusively in this position and may not also function in an executive capacity for another insurance product. The Behavioral Health Medical Director shall share responsibility for the management of the behavioral health services delivery system with the Behavioral Health Coordinator, and shall be actively involved in all major clinical and quality management components of the behavioral health services of the MCO. The Behavioral Health Medical Director shall meet regularly with the Medical Director. The Behavioral Health Medical Director’s responsibilities shall include, but not be limited to, the following: 2.3.3.4.1 Oversee, monitor, and assist with the management of psychopharmacology pharmacy benefits manager (PBM) activities, including the establishment of prior authorization, clinical appropriateness of use, and step therapy requirements for the use of stimulants and antipsychotics for all enrollees under age 18; 2.3.3.4.2 Provide clinical case management consultations and clinical guidance for contracted primary care physicians (PCPs) treating behavioral health-related concerns not requiring referral to behavioral health specialists; 2.3.3.4.3 Develop comprehensive care programs for the management of youth and adult behavioral health concerns typically treated by PCPs, such as ADHD and depression; Page 51 of 347 2.3.3.4.4 Develop targeted education and training for MCO PCPs to screen for mental health and substance use disorders using evidence-based tools (e.g., AUDIT- C, PHQ-9 and GAD-7), perform diagnostic assessments, provide counseling and prescribe pharmacotherapy when indicated, and build collaborative care models in their practices; 2.3.3.4.5 Coordinate with the Medical Director to integrate the administration and management of behavioral and physical health services; 2.3.3.4.6 Oversee, monitor and assist with effective implementation of the Quality Management (QM) program; and 2.3.3.4.7 Work closely with the Utilization Management (UM) of services and associated appeals related to children and youth and adults with mental illness and/or substance use disorders (SUD). 2.3.3.5 The Chief Financial Officer (CFO) shall oversee the budget, accounting systems, financial reporting, and all audit activities implemented by the Contractor. The CFO shall be a full-time position (minimum forty (40) hours weekly) based in Louisiana and may not function in an executive capacity for another insurance product. He or she shall attend meetings in person, when requested. 2.3.3.6 The Pharmacy Director shall be located and licensed in Louisiana, with at least five (5) years’ experience as a pharmacist practicing in a retail setting with managerial experience. The Pharmacy Director shall serve full-time (minimum forty (40) hours weekly) and may not function in this capacity for another insurance product. He or she shall attend meetings in person, when requested. 2.3.3.7 The Contract Compliance Officer shall serve as the primary point of contact for all communications and requests related to this Contract, including but not limited to, all compliance issues. The incumbent shall manage the connection of MCO personnel to LDH business owners, and shall develop and implement written policies, procedures, and standards to ensure compliance with the requirements of this Contract. These primary functions may include, but are not limited to, coordinating the tracking and submission of all Contract deliverables, fielding and coordinating responses to LDH inquiries, coordinating the preparation and execution of Contract documents, audits and ad hoc visits. This position shall report directly to the CEO and board of directors in accordance with 42 C.F.R. §438.608(a)(1)(ii). 2.3.4 Additional Required Staff 2.3.4.1 The Contractor shall have sufficient number of qualified staff with sufficient experience and expertise to meet both physical health services and behavioral health services responsibilities, and shall provide dedicated staff where necessary to meet this obligation including all required timeframes and geographic coverage outlined in this Contract. 2.3.4.2 The Contractor shall comply with additional staffing requirements included in the MCO Manual. Mental Health Parity 2.3.11.1 The Contractor shall comply with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, which requires parity between mental health or substance use disorder benefits and medical/surgical benefits with respect to financial requirements and treatment limitations. The Contractor shall comply with all requirements set forth in 42 C.F.R. Part 438 Subpart K, for all Medicaid managed care enrollees. § 438.900 Meaning of terms. FQHC FQHC means Federally qualified health center. CMS CMS stands for Centers for Medicare & Medicaid Services, formerly the Health Care Financing Administration (HCFA). For purposes of this subpart, except where the context clearly indicates otherwise, the following terms have the meanings indicated: Aggregate lifetime dollar limit means a dollar limitation on the total amount of specified benefits that may be paid under a MCO, PIHP, or PAHP. Annual dollar limit means a dollar limitation on the total amount of specified benefits that may be paid in a 12-month period under a MCO, PIHP, or PAHP. Cumulative financial requirements are financial requirements that determine whether or to what extent benefits are provided based on accumulated amounts and include deductibles and out-of-pocket maximums. (However, cumulative financial requirements do not include aggregate lifetime or annual dollar limits because these two terms are excluded from the meaning of financial requirements.) Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefits are benefits defined in section 1905(r) of the Act. Financial requirements include deductibles, copayments, coinsurance, or out-of-pocket maximums. Financial requirements do not include aggregate lifetime or annual dollar limits. Medical/surgical benefits means benefits for items or services for medical conditions or surgical procedures, as defined by the State and in accordance with applicable Federal and State law, but do not include mental health or substance use disorder benefits. Any condition defined by the State as being or as not being a medical/surgical condition must be defined to be consistent with generally recognized independent standards of current medical practice (for example, the most current version of the International Classification of Diseases (ICD) or State guidelines). Medical/surgical benefits include long term care services. Mental health benefits means benefits for items or services for mental health conditions, as defined by the State and in accordance with applicable Federal and State law. Any condition defined by the State as being or as not being a mental health condition must be defined to be consistent with generally recognized independent standards of current medical practice (for example, the most current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the most current version of the ICD, or State guidelines). Mental health benefits include long term care services. Substance use disorder benefits means benefits for items or services for substance use disorders, as defined by the State and in accordance with applicable Federal and State law. Any disorder defined by the State as being or as not being a substance use disorder must be defined to be consistent with generally recognized independent standards of current medical practice (for example, the most current version of the DSM, the most current version of the ICD, or State guidelines). Substance use disorder benefits include long term care services. Treatment limitations include limits on benefits based on the frequency of treatment, number of visits, days of coverage, days in a waiting period, or other similar limits on the scope or duration of treatment. Treatment limitations include both quantitative treatment limitations, which are expressed numerically (such as 50 outpatient visits per year), and nonquantitative treatment limitations, which otherwise limit the scope or duration of benefits for treatment under a plan or coverage. (See § 438.910(d)(2) for an illustrative list of nonquantitative treatment limitations.) A permanent exclusion of all benefits for a particular condition or disorder, however, is not a treatment limitation for purposes of this definition.

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

Phone Directory

Franciscan Missionaries of Our Lady Health System

Corporate Office: (225) 923-2701
Patient Billing/Customer Service: (225) 765-8872
Materials Management/Purchasing: (225) 526-4500
Medical Records: (225) 765-6580
IS (Information Services): (225) 526-5959

Below are links to the most commonly used phone numbers at each of the following:

Our Lady of Angels Hospital

Our Lady of the Lake Ascension

Our Lady of Lourdes Regional Medical Medical Center

Our Lady of the Lake Children's Health

Our Lady of the Lake Regional Medical Center

St. Francis Medical Center

St. Dominic's

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January 19, 2022

FMOLHS OLOL Zielinski, Robinson Physician Group: “This defendant blatantly violated the trust bestowed upon him by the Our Lady of the Lake Foundation and people they serve by stealing valuable resources from those who needed it most"

“This defendant blatantly violated the trust bestowed upon him by the Our Lady of the Lake Foundation and people they serve by stealing valuable resources from those who needed it most"

U.S. Attorney Brandon J. Fremin.

BATONROUGE, La. (WAFB) - A judge sentenced Former Our Lady of the Lake fundraiser John Paul Funes to 33 months in prison Thursday (Oct. 24). He will also have to pay a $50,000 fine.

Standing with a shaking voice in front of Judge John deGravelles, Funes apologized to former colleagues at the hospital he once worked for, to his family, and to the victims.

"The crimes and sins I committed were a result of weakness," Funes said. "I lived a culture of lies."

Funes is convicted of stealing nearly $800,000 from the Our Lady of the Lake Foundation for personal use. The foundation raises money for Our Lady of the Lake Regional Medical Center and its affiliate hospitals.

He has repaid the $800,000 to the hospital, and will pay the $50,000 fine to the U.S. Government.

Funes made his first court appearance Wednesday, June 12, in which he waived his right to a grand jury indictment and a preliminary hearing. He pleaded guilty to federal charges of wire fraud and money laundering Thursday, June 20.

Prosecutors say Funes, 49, flew family and friends to LSU and New Orleans Saints football games under the guise of “outbound patient transports,” and labeled gift cards he purchased for himself as gifts for cancer patients in order to balance the hospital’s books.

Funes said he prays for the victims of his crimes every day and described his crimes as “awful and senseless.”

“The pain, regret, and remorse I feel is almost as hard to process as the crimes,” he said.

For a similar, first-time white-collar criminal, the federal government typically recommends sentences of 33 to 41 months in jail, accompanied by $15,000-$500,000 fines. Green asked the judge to sentence Funes to just a year-long prison term.

Funes says he’s spent an hour each week in therapy for the past 11 months and saw a counselor as recently as the day before his sentencing.

"I will spend the rest of my life showing these family members who I really am," Funes said.

"These wounds were self-inflicted," Funes' lawyer, Walt Green said.

Green says Funes sought out parents of cancer patients on his own to apologize to them. Two of those parents wrote deGravelles letters in support of Funes.

"This is the most difficult sentencing I've had in all my years on the bench," Degravelles said.

“This was done over and over and over again over a period of six years," the judge said. “This was not a case of Robin Hood.”

Two former LSU football players, Vadal Alexander and Rohan Davey, have found themselves indirectly tied up in the Funes saga.

The money received by James Alexander from Funes was transferred while his son was still on the LSU football team, the sources say.

Funes also sent checks totaling around $107,000 to the mother and sister of former LSU football player Rohan Davey. The pair ultimately funneled back about $63,000 of the money to Funes, sources said.

Davey was not an LSU player when Funes made payments to his relatives. In court, federal prosecutors made reference to the Davey family as ‘victims’ who were sucked into Funes’s scheme.

“I can’t comment on any NCAA investigation or whether there is one or not,” Green said in an interview with WAFB. He would not say whether he or Funes has been contacted by NCAA representatives.

Funes will turn himself in to prison in early December. He could be released a few months early on good time.

RECENT DENIAL OF TREATMENT

BY PRIMARY CARE PHYSICIAN, J. MICHAEL ROBINSON, DURING CONTRACTION OF COVID-19 SELF-QUARANTINE, WHEREBY a PHYSICIAN FROM SAME FMOLHS OLOL, PHYSICIAN GROUP, DID INITIALLY, UNDER PROTEST, AGREE TO PROVIDE 1 EMERGENCY PRESCRIPTION TO AVOID SERIOUS COMPLICATIONS OF WITHDRAWAL;

COVID SYMPTOMS, DIAGNOSED CELLULITIS HE LEFT UNTREATED, DANGEROUSLY IGNORING INFECTION OF BOTH LEGS.

HAVING RESPONDED TEMPORARILY TO ER COURSE OF ANTIBIOTICS, THEN SECOND COURSE, BEGRUDGINGLY PRESCRIBED BY ROBINSON, WHOSE INITIAL, CURSORY, NO-TOUCH, VISUAL ONLY, IN-OFFICE EXAMINATION, RENDERED THE BAD NEWS TO THE OLOL ER SPECIALIST AND TWO OTHER PHYSICIANS:

CURRENT DOCTOR ROBINSON, NOT ONLY REFUSING TO PRESCRIBE ANY OF THE SAME MEDICATION AS I HAD JUST RECEIVED IN THE ER RUN BY THE SAME INSTITUTION AS WAS HIS PHYSICIAN GROUP CLINIC, BUT INSTEAD, AFTER RELENTING ON FIRST VISIT TO PRESCRIBE TRAMADOL, ON FOLLOW-UP CHANGING HIS MIND.

REASONS TO REASSESS PATIENT TERMINATION

EXCEPT AS LAST RESORT

COVID-19 PANDEMIC UPDATE POLICY FOR FEDERAL HEALTHCARE PROVIDERS AND INSTITUTIONS WHO RECEIVE REIMBURSEMENT THROUGH US GOV AFFORDABLE CARE / CMS MEDICAID INSURANCE BEST PRACTICE

REGARDING TERMINATION OF PATIENT FROM PRACTICE: DURING PANDEMIC, SHORTAGE OF DOCTORS, ALLOWANCE SHOULD BE CONSIDERED FOR PLACEMENT WITH ANOTHER DOCTOR OF ASSOCIATED PRACTICE FOR CONTINUITY OF CARE.

ALLOWANCE FOR TELEVISIT APPOINTMENTS

PROVIDING AT-RISK PATIENTS WITH RELAXED PRESCRIPTIONS

Assistant Professor, LSU-NO Baton Rouge, Health Science, Resident Program Supervisor

this is John PaulSongs With the Mascari

Our Lady of the Lake

TO SCHEDULE VISIT 225-765-5500 on-line MyChart In-Person Video visits performed by board-certified #fmolhs Franciscan Missionaries of Our Lady Health System providers. schedule appointment new (225) 765-5500 *existing patient

*unless, like me, you are being denied consumer services through, but not limited to:

1. Administrative locking of patient records (made inaccessible to all operators, patient, administrative personnel, rendering no access or information, and notations.

2. Universal FMOLHS OLOL-RMC No Contact Order Notation and Legal Counsel Directive, per Ms. Bollinger, Mr. Vrath MD. Denying any and all Services offered and prohibiting inquiries and Emergency medical attention from General Physician, and all Executive Directors and their representatives.

3. Illegally Removed Patient Access to non-FMOLHS, non-OLOL, non-Physician Group, Online Patient Account (MyChart is a third-party website).

Deactivation of Personal Patient Medical Account, against State, Federal CMS, AMA, HHS;

Manipulation of Protected Confidential, Private Account (MyChart), further hindering Patient Request of Access to Due Process and Appeal, as well as Institutional Denial of Grievance, and report of malicious retaliation through all, but not limited, fraudulent charges

RETALIATORY PATIENT ABANDONMENT (THROUGH FRAUDULENT FALSE REPORT)

SEVERING OF PATIENT/PHYSICIAN/CLINIC JUNE 2, 2021

FMOLHS REFUSAL TO COMMUNICATE by TELEPHONE, ELECTRONIC MAIL, OFFICIAL SOCIAL MEDIA ACCOUNTS

dis-enrolled,

2.5.1.9 The Contractor shall provide a mechanism to reduce inappropriate and duplicative use of healthcare services, including but not limited to potentially preventable hospital emergency departments visits and inpatient readmissions

PART 2: CONTRACTOR RESPONSIBILITIES

Compliance

2.1.1 The Contractor shall comply, to the satisfaction of LDH, with: (1) all requirements set forth

in this Contract; (2) all provisions of state and federal laws, regulations, rules, the State Plan,

and waivers applicable to managed care; and (3) the MCO Manual.

2.1.2 The Contractor shall comply with federal statutes and regulations governing managed care, including, but not limited to, all applicable provisions of

2.1.5 The Contractor shall comply with all court-ordered requirements, including but not limited to, United States v. State of Louisiana (DOJ Agreement- Case-3:18-cv-00608) and Chisholm v. Gee (Case 2:97-cv-03274) in the manner determined by LDH.

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