Don’t Be So Quick to Click That Metric Button

I just saw this and couldn’t believe it:

A Kentucky doctor convicted of Medicaid fraud has been sentenced to five years in prison and ordered to pay more than $10,000 in restitution.
Authorities say 58-year-old Dr. Ezekiel O. Akande of Somerset was sentenced late last week by Pulaski Circuit Court Judge David A. Tapp.
State Attorney General Andy Beshear’s office says a Somerset jury convicted Akande in March for Medicaid fraud and theft by unlawful taking over $10,000.
Beshear’s office says Akande operated the Somerset Regional Pain Center. Prosecutors say he stood trial for receiving payment from Kentucky’s Medicaid program for tobacco cessation counseling he did not perform.
Beshear’s Office of Medicaid Fraud and Abuse handled prosecution of the case.

I searched this story pretty hard and this was basically his whole crime.  He basically kept saying that he did tobacco cessation counseling on, well, maybe everyone.  Let’s play devil’s advocate here.  Maybe his staff clicked the button.  Maybe it was a text macro he kept using.  Maybe he was just getting greedy because he couldn’t survive in the industrialized model on his own. Who knows?  But five freaking years in prison?  Are you kidding me?

I welcome your thoughts on this.  Am I off base on this?  Or, maybe you have more information I am not seeing?

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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  11 comments for “Don’t Be So Quick to Click That Metric Button

  1. October 28, 2017 at 12:42 pm

    As a retired software engineer, I’m tired of people foisting their own malfeasance on “computer error”. Regardless of what kind of system he was using, who was inputting the data, HE was responsible for what was reported for reimbursement, and HE was responsible for what ended up in the medical records. Computers are fine for this, but a human has to look to see that everything is working properly. Someone who was a lifelong non-smoker being billed for “smoking cessation” should get someone’s attention. Also, he should have accountants looking over his records on how much is reimbursed for what, and on whose behalf. If errors were found, the excess money returned with an explanation of how it happened and what steps were put in place to see that it wouldn’t happen again. When it takes formal charges to get the money returned, it’s willful theft – from the taxpayers in this case. Yes, it warrants a prison sentence along with the money returned. This money should be used to care for actual sick people, not for BS charges for services that patients neither wanted, needed, nor could use.

    • Pat
      October 29, 2017 at 4:17 pm

      Beth K said: “Also, he should have accountants looking over his records on how much is reimbursed for what, and on whose behalf.”

      Beth, you made some reasonable points about human oversight, however you obviously don’t get the larger issue. Very few if any primary care docs have extra cash to dole out to accountants to check for mistakes. The overhead for a mainstream primary care office is ridiculous as it is; a large reason is having to may for mandated EHR’s and the periodic updates and licenses generated by your people, and the IT man forever on retainer for the inevitable electronic “oops.”

      Beth the larger point here is that EHR’s make mistakes more – not less – likely, and do very much increase the risk of a helpful government auditor being able to claim fraud over mis- or up-codings that may or may not have been intentional. This particular doc may be a very bad guy but…the larger point is that the forced use of computers for all things medical has made medical care worse, and has increased the profile of every doc as a potential target.

  2. Tom fiero
    October 26, 2017 at 10:37 am

    We need t see the details.
    I think t bill for smoking cessation counseling one needs t spend ten minutes of face t face with the patient talking just about smoking( need t recheck latest requirement).
    Did he bill such for “every “ patient?
    We need t see the details.
    Five years does seem extreme.

    • Doug Farrago
      October 26, 2017 at 1:55 pm

      The info I am seeing is that he probably ran a pill mill and the Feds went after him for EVERYTHING

  3. DrWally
    October 25, 2017 at 5:41 pm

    Upon further investigation, the good doctor is a pain specialist also charged by the Feds with 8 counts of distributing and dispensing schedule II narcotics. His bond for that charge is $500,000.
    I believer the tobacco issue is a state medicaid issue and he has not yet come to trial on the Federal charges.
    All found after I Googled his name.

  4. hawgguy
    October 25, 2017 at 4:11 pm

    EMR can make criminals out of all of us. Either under-code or over-code. I have been reprimanded for under-coding poor patients as it suggested I was providing them less care because they were poor. I thought I was cutting them a break.

    I wonder if the doc in this story was running a pill mill and that was the true reason he was targeted? They jailed Al Capone for tax fraud.

  5. Bill Ameen MD
    October 25, 2017 at 10:17 am

    Absurd. With the shortage of doctors taking Medicaid anyway, everywhere!? Since Kentucky is either #1 or #2 in the nation in tooth loss secondary to tobacco use, then likely every one of this poor guy’s patients was a smoker. I didn’t know that Medicaid reimburses more for tobacco cessation counseling since I never took Medicaid! How the hell did the feds know he DIDN’T counsel??

  6. John Parkin M.D.
    October 25, 2017 at 8:56 am

    A colleague of mine was working for a large Midwestern healthcare company at a small primary care clinic. He reported another doc to this company with concerns over excess documentation including visits that never happened. The company defended the fraudulent doc and reprimended the reporter ! Obviously $$ is more important than ethics or laws.

  7. Sir Allyagottadois
    October 25, 2017 at 7:53 am

    The government is using the EMR and the malpractice attorneys are just starting. Will there be any physician’s left to care for me when I get old? Not to worry, I’ll just see a NP.

  8. Pat
    October 25, 2017 at 7:07 am

    In one of the ER’s where I work, I counsel 100% of the smokers to quit, and so document. So will that now be used as a basis for a fraud charge if my staffing company or the hospital receives any tobacco money? And yet, if I DONT annotate smoking cessation counseling, I can be legally liable when one of these chronic lungers gets cancer or an MI.

    The story did not specify exactly how this guy committed fraud, but I agree, five years is well beyond reasonable or just.

    I actually think medicine is becoming an increasingly frightening field. Doctors are already targets to lawyers and patients; as money gets tighter, states and the Feds will target doctors more and more. I really wish I had been foresighted enough to develop a different marketable skill. No one with any sense should go into this toxic profession.

    • Steve O'
      October 25, 2017 at 8:09 am

      At end stage, the bureaucratic society believes that all individuals are criminals with no moral code. Only the bureaucracy has a moral code, they insist; it must oversee the lesser races, as it were, as they are merely clusters of human animals and have no means except for their own wretched cultures and communities.
      Also, there must be an assumption that there exist classes which are very wealthy, but also utterly corrupt and without any moral standards. Robin Hood exists, therefore, not to steal from the rich and give to the poor; but steal from the unworthy and give to the worthy.
      The myth is that once righteous entities – “quality enforcers” – squeeze unwanted intermediaries, such as doctors, out of the healthcare system, the massive prosperity which it seems to represent can be fairly shared with all, once we get rid of the doctors who are soaking up all that wealth!
      There is no massive trove of “doctor wealth.” We have dug down near this secret horde; when we open the chest, there will be nothing inside.

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