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,MichaelD.MD
Otolaryngology
Our Lady of the Lake Head and Neck Center 4950 Essen LaneSuite 400Baton RougeLA70809
The National Cancer Instituteestimates 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.
The Providers listed below* are part ofOur Lady of the LakePhysician Group, LLC and are covered by the financial assistance program offered at FranciscanMissionaries of Our Lady HealthSystem (FMOLHS) Hospitals (FAP) covers emergency and medically necessary services provided touninsured and underinsuredpatients 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 70809
1 hr 9 min(3.5 miles)
via Perkins Rd
Mostly flat
Use caution–walking directions may not always reflect real-world conditions
Head east toward Constitution Ave
102 ft
Turn left toward Constitution Ave
220 ft
Turn right onto Constitution Ave
0.1 mi
Constitution Ave turns slightly right and becomes Bunker Hill Dr
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200 ft
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194 ft
Turn left onto Perkins Rd
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Our Lady of the Lake Head & Neck Center
4950 Essen Ln Suite 400, Baton Rouge, LA 70809
These directions are for planning purposes only. You may find that
construction projects, traffic, weather, or other events may cause
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route accordingly. You must obey all signs or notices regarding your
route.
ZielinskiMarkH.MDPsychiatryOur Lady of the Lake Physician Group Psychiatry-O'Donovan 5131 O'Donovan Drive Suite 300Baton RougeLA70808
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.
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.
Medicaid Fraud involves the intentional submission of a false or fraudulent claim to the Louisiana Medicaid program.
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.
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.
Imprisonment for up to 10 years
Fines up to $10,000
Prohibited from working in a health care facility for a minimum of 5 years.
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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