Dr. Michael D. DiLeo, MD Otolaryngology Oncology Emergency (HHS-OIG: FMOLHS OLOL) Medicaid Beneficiary Cancer Biopsy Denial (1 week 6.7.22) LSU-Franciscan Missionaries Our Lady Health System Lake Physician Group Head and Neck Center, 4950 Essen Ln Suite 400 (225) 765-1765 Baton Rouge, LA 70809 NPI 1578563474
DiLeo, Michael D. MD
Otolaryngology
Our Lady of the Lake Head
and Neck Center
4950 Essen Lane Suite 400 Baton Rouge LA 70809
The National Cancer Institute estimates that 14.5 million persons in the United States have cancer, and that number could reach 19 million by 2024. Family physicians should be familiar with the most prevalent oncologic emergencies because stabilization is often necessary, in addition to referrals for managing the underlying malignancy and initiating palliative measures.
Some oncologic emergencies are insidious and take months to develop, whereas others manifest over hours, causing devastating outcomes such as paralysis and death. In many patients, cancer is not diagnosed until a related condition emerges. A patient-focused approach that includes education; cancer-specific monitoring; and team-based care, including palliative care, with continuous communication is recommended.
Most oncologic emergencies can be categorized as metabolic, hematologic, structural, or treatment related.
About Michael D. DiLeo
Michael D. DiLeo, MD is a native of New Orleans and received his undergraduate degree in chemical engineering at Louisiana State University in Baton Rouge in 1986. He completed his medical degree at Louisiana State University Medical Center in Shreveport in 1990. After a two year internship in general surgery, he completed his Otolaryngology - Head and Neck Surgery residency at Tulane Medical Center in New Orleans in 1996. His residency was followed by fellowship training in Head and Neck Surgery Oncology and Microvascular Reconstruction at Hehnemann Hospital in Philadelphia, PA.
Ultimately the hospitals suffered from low Medicaid payments and couldn't find a way to break even. Many observers — from former presidential candidate Bernie Sanders to Philadelphia Mayor Jim Kenney — saw a simple reason for the closure last summer of Hahnemann University Hospital: greed.Jun 20, 2020
Dr. DiLeo received his Board Certification from the American Board of Otolaryngology in 1997. He started his medical practice in Atlanta, GA in 1997, specializing in head and neck surgical oncology and microvascular reconstructive surgery. In 2001, Dr. DiLeo returned to Louisiana in private practice. In 2007, he joined the LSU Department of Otolaryngology as an assistant clinical professor. In 2010, he became a member of Our Lady of the Lake Physician Group and now practices full-time at the joint LSU-Our Lady of the Lake Head and Neck Clinic. Dr. DiLeo's clinical practice focuses on head and neck cancer surgical oncology and complex microvascular plastic and reconstructive surgery of the head and neck.
| NPI | Name | NPI Type | Primary Practice Address | Phone | Primary Taxonomy |
|---|---|---|---|---|---|
| 1578563474 | MICHAEL DILEO |
| 4950 ESSEN LN STE 400 BATON ROUGE, LA 70809-3738 | 225-765-1765 | Otolaryngology |
Our Lady of the Lake
The Providers listed below* are part of Our Lady of the Lake Physician Group, LLC and are covered by the financial assistance program offered at Franciscan Missionaries of Our Lady Health System (FMOLHS) Hospitals (FAP) covers emergency and medically necessary services provided to uninsured and underinsured patients at FMOLHS hospitals. Assistance for underinsured patients is meant to address gaps in coverage and does not cover co-pays, deductibles, or co-insurance for insured patients. For detailed information on the program, or an application to apply, visit
Our Lady of the Lake Regional Medical Center is a general medical and surgical facility located in Baton Rouge, Louisiana.
It is a Catholic hospital member of the Franciscan Missionaries of Our Lady Health System
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Home to Our Lady of the Lake Head & Neck Center, 4950 Essen Ln Suite 400, Baton Rouge, LA 708091 hr 9 min (3.5 miles)
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Our Lady of the Lake Head & Neck Center
4950 Essen Ln Suite 400, Baton Rouge, LA 70809
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Zielinski Mark H. MD Psychiatry Our Lady of the Lake Physician
Group Psychiatry - O'Donovan
5131 O'Donovan
Drive
Suite 300 Baton Rouge LA 70808
Department of Justice
Office of Public Affairs
FOR IMMEDIATE RELEASE
Wednesday, November 13, 2019
Louisiana Department of Health to Pay $13.42 Million to Settle Alleged False Medicaid Claims for Nursing Home and Hospice Care
The Louisiana Department of Health has agreed to resolve allegations that it submitted false and inflated Medicaid claims for long-term nursing home and hospice care, the Department of Justice announced today. Under the settlement agreement, the state agency has agreed to pay $13,422,550.
“Today’s settlement demonstrates that we will take whatever steps are appropriate in our effort to protect federal healthcare programs, including Medicaid, from false claims,” said Assistant Attorney General Jody Hunt for the Department of Justice’s Civil Division. “Anyone who seeks to profit at the expense of Federal taxpayers, including state agencies, will face appropriate consequences.”
“This office will remain vigilant in its efforts to ensure the integrity of the Medicaid program by continuing to pursue those who commit improprieties against the program – whether they be providers or beneficiaries, or those more central to the administration of the program,” said Brandon J. Fremin, the U.S. Attorney for the Middle District of Louisiana. “The people of Louisiana deserve it. I am grateful to the dedicated AUSAs and staff in our Civil Division and to the Office of Inspector General for the U.S. Department of Health and Human Services for their hard work and dedication to this very important matter.”
Medicaid is a joint federal and state program providing financial assistance to individuals with low incomes to enable them to receive medical care. The Medicaid program makes quarterly grant awards to each participating state covering an amount, commonly known as the federal share, of the state’s expenditures for healthcare services covered by the state’s Medicaid plan. The federal share is determined by a percentage rate that is subject to change from quarter to quarter. Nursing homes and hospices typically submitted claims to Louisiana on the tenth day of the month following the month during which the services were actually provided. Louisiana then paid these claims, sought Federal reimbursement for those expenditures, and received Federal reimbursement based on the rate in effect at that time.
The United States alleged that the Louisiana Department of Health knew that the rates determining the federal share of Louisiana’s Medicaid payments were set to decrease following the months of December 2010, March 2011, June 2011, and September 2013. To receive the higher Federal share percentage rates in effect during these months, the Louisiana Department of Health fraudulently caused its healthcare contractor, Molina Medical Solutions, to prepare, submit, and pay claims for nursing home and hospice services in these months, before the providers had submitted to Louisiana any claims for them. Louisiana then claimed Federal reimbursement for those premature payments. As a result, the Louisiana Department of Health received a Federal share based upon the higher percentage rate in effect in those months, rather than the lower percentage rate in effect the following months when the providers actually submitted their claims to Louisiana.
This settlement was the result of an investigation by the Civil Division of the Department of Justice, the U.S. Attorney’s Office for the Middle District of Louisiana, and the U.S. Department of Health and Human Services Office of Inspector General.
The claims resolved by this settlement are allegations only, and there has been no determination of liability.
Component(s):
Press Release Number:
19-1240
Medicaid Fraud
PHONE:
225-326-6210
888-799-6885
FAX:
225-326-6295
EMAIL:
MFCUInfo@ag.louisiana.gov
Since 1978, Louisiana’s Medicaid Fraud Control Unit (MFCU) has been
recognized as a national leader in the investigation and prosecution of
Medicaid fraud and nursing home abuse. In that time, the Louisiana MFCU
has convicted hundreds of persons for program violations and recovered
millions of tax dollars. The unit has been recognized three times as the
number one MFCU in the nation by the United States Department of Health
and Human Services, Office of the Inspector General.
The mission of the MFCU is to aggressively combat the fleecing of taxpayers by fraudulent health care providers. Furthermore, the MFCU seeks to protect our most vulnerable citizens--the elderly and mentally disabled - and vigorously prosecute criminals who prey on them.
The mission of the MFCU is to aggressively combat the fleecing of taxpayers by fraudulent health care providers. Furthermore, the MFCU seeks to protect our most vulnerable citizens--the elderly and mentally disabled - and vigorously prosecute criminals who prey on them.
Medicaid Fraud involves the intentional submission of a false or fraudulent claim to the Louisiana Medicaid program.
The three primary Medicaid fraud schemes are:
The three primary Medicaid fraud schemes are:
- Providers who bill the government for services they never performed.
- Upcoding- Providers who bill the government for more expensive services than they actually performed.
- Kickbacks- Providers who make illegal payments to third parties in exchange for business or referrals billed to Medicaid
Examples of Medicaid Fraud prosecuted by the MFCU in the past:
- A Kid-Med clinic in the New Orleans area submits billings for physician office visits when the clinic has no licensed physician on staff.
- A physician bills Medicaid for face-to-face office visits when she was vacationing outside the United States.
- A New Orleans dentist pays solicitors for each patient brought in to his clinic for dental services.
- A home health nurse submits false time sheets for seeing patients who are actually hospitalized.
- A Winnsboro transportation company bills for trips not made and exaggerated mileages (such as billing for more than 2,000 miles in an 8 hour period).
Medicaid Fraud Penalties Include:
Imprisonment for up to 5 years
Fines up to $20,000
Civil penalties of $2,000 per false claim
Exclusion from Medicaid
You can sue for fraud on behalf of the State.
Under a 1997 law, a private person may file a qui tam lawsuit on behalf of the state Medicaid program to seek recovery for fraud committed by health care providers.
Who may file a qui tam suit? A qui tam plaintiff must be an original source of the information which serves as the basis for the lawsuit.
If the qui tam lawsuit is successful, the plaintiff may receive from 10% to 30% of the recovery. The plaintiff is also entitled to recover expenses and attorneys fees.
Under a 1997 law, a private person may file a qui tam lawsuit on behalf of the state Medicaid program to seek recovery for fraud committed by health care providers.
Who may file a qui tam suit? A qui tam plaintiff must be an original source of the information which serves as the basis for the lawsuit.
If the qui tam lawsuit is successful, the plaintiff may receive from 10% to 30% of the recovery. The plaintiff is also entitled to recover expenses and attorneys fees.
Abuse and Neglect of the Elderly and
Disabled residents of health care facilities is a crime. The four
primary types of abuse are:
- Physical Abuse: Physical abuse is any type of physical injury inflicted on any resident. Physical abuse includes hitting, slapping, choking and pinching, as well as using any object or giving any substance to a resident which causes unnecessary pain or suffering.
- Financial Abuse: Stealing money or property from a resident, regardless of its value, is financial abuse. Also, simply using a resident’s property without permission or obtaining permission fraudulently is financial abuse.
- Sexual Abuse: Sexual abuse occurs when someone commits a sexual act against a resident, or forces the resident to commit a sexual act on another. However, normal sanitary care or medical treatment is not sexual abuse.
- Verbal Abuse: Inflicting mental or emotional distress through one’s words is verbal abuse. This abuse can be caused by making threats, ridiculing, or cursing residents.
Holden Enterprises, L.t.d. is a business incorporated
with Colorado Department of State (CDOS). The Entity Identifier is
#20201085666. The business address is 17117 S Harrells Ferry Rd, Baton
Rouge, LA 70816, US. The business entity type is Foreign Limited Liability Company.
Terri Van Camp
Senior Procurement Specialist
Terri has four years of experience as a business analyst and materials support staffer for Entergy's transmission and standards department.
Her duties have included tracking materials information in Asset Suite, overseeing requisitions, managing relationships with purchasing and store room departments, communicating with vendors and providing regular updates to adjacent teams.
She was previously manager and co-owner of Bayou Fitness 24/7 and Combat Sports, LLC., where she oversaw finances and staff.
Before that, she was a purchasing agent at Franciscan Missionaries of Our Lady Health System.
Terri holds a bachelor's degree in marketing from the University of New Orleans.
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