Do healthcare professionals believe they are above the law?

Medicare Fraud_1

Do healthcare professionals believe they are above the law?

Medicare fraud is no secret and healthcare providers are found guilty quite frequently for mismanagement of government funds. Some of this misconduct may not be intentional but when allegations lead to indictments it may be safe to conclude that there is little to question. And with all the publicity on convictions and prison time for mismanaging Medicare funds one can’t help but to wonder why are healthcare professionals still indulging in this fraudulent behavior? Could it be that they believe that they are not ever going to get caught? Are they so far gone with defrauding the government that they can’t stop their wrong doings? Could they actually believe they are above the law and can continue this ill-behavior indefinitely without ever paying a price? Well regardless of what the reasons may or may not be, the reality is that Medicare fraud is a serious crime with serious consequences.

Example of Medicare fraud in Atlanta, Georgia

In February 2014 a Dr. Lawrence Eppelbaum, a physician in Atlanta Georgia was sentenced to prison and fined $3.5 million dollars for defrauding Medicare and the IRS. He was convicted for 27 counts of healthcare fraud, tax fraud and money laundering. Dr. Eppelbaum who is licensed by the state of Georgia to practice medicine operated the Atlanta Institute of Medicine and Rehabilitation (AIMR) and the Pain Clinic of AIMR. The AIMR is a reputable healthcare organization in the Atlanta area and has helped many patients who experience chronic pain. In 2004 Dr. Eppelbaum created the Back Pain Fund” through the AIMR. He had total control over the Back Pain Fund”, directly and indirectly. From 2004-2009 Eppelbaum received more than $16 million dollars from Medicare for the care he provided to his patients. Unfortunately he mismanaged these government funds and evaded paying the IRS more the than a million dollars that he owed through his organization. Now Eppelbaum has to pay the price for his misconduct as a physician in the healthcare profession.

There are many more examples of healthcare fraud in Georgia committed by healthcare professionals. I have listed the above example because of the depth of this physician’s convictions and the consequences he suffered. I also used this illustration to point out that when someone has total control over any funding organization, the environment becomes an ideal place for fraud and/or embezzlement to take place.

In summary

Medicare fraud is a reality in the United States. In May of 2014, the Medicare Fraud Strike Force published a report, charging 90 individuals (27 medical professionals, including 16 physicians) for false Medicare billing in the amount of $260 million dollars.  So even though it appears to be a lot of media-hype about healthcare fraud, there is also a lot of real-life situations taking place among healthcare professionals and lay people.

Sadly, every time Medicare fraud takes place, funds are taken away from the future of caring for our senior population. This is bad news but there is also good news. We all can play a significant part in putting a halt to Medicare fraud because we now have the power. So if you or anyone you know is aware of any Medicare fraudulent acts and want to make a difference, please visit the Stop Medicare Fraud website and/or the Medicare Fraud Reporting Center and let your voice be heard. Remember, what affects one eventually affects another. Believe it or not, we are all in this together! So let us all stand tall and strong against Medicare fraud and make the difference!



What is medical misconduct? Can it be stopped?

Unlawful Medicine

What is medical misconduct?

What is medical misconduct? Medical misconduct is defined as behavior that deviates from duty by a healthcare professional. Examples of medical misconduct include, but are not limited to the following: practicing as a healthcare professional fraudulently, practicing with gross incompetence or medical negligence, practicing while impaired by alcohol, drugs, physical or mental disability, being convicted of a crime, filing a false report; guaranteeing that treatment will result in a cure, refusing to provide services because of race, creed, color or national origin, performing services that are not authorized by the patient, harassing, abusing or intimidating a patient, ordering excessive tests, and/or abandoning or neglecting a patient in need of immediate care.

In the past patients looked upon doctors as heroes, totally believing in their medical advice and respecting the medical care they provided. Then patients very seldom questioned doctors but now I would have to say that things are much different. And unfortunately with the increase in medical misconduct over the years, many people have lost faith in doctors and the healthcare profession.

There are many medical misconduct cases throughout the United States. In the Nashville area, the New Life Lodge Rehabilitation Center has been sued twice for the death of a patient. The latest suit was filed by Penny Lynn Bryant, a mother seeking a total of $13 million in compensation and damages. She says that her son was prescribed medications he should not have been and was unresponsive for about four hours before being discovered by staff. Her son Patrick Bryant who was admitted to the center for drug rehab died on his 20th birthday, July 16 2011. New Life Lodge and its former lead physician Dr. Jonathan W. Butler are accused of medical malpractice, negligence and wrongful death in Bryant’s passing. The New Life Lodge Rehabilitation Center has another pending lawsuit against their facility in the amount of $32 million for the death of 29 y/o Lindsay Poteet who died of combined drug toxicity, a mix of anti-depressant and therapeutic drugs.

Things have definitely changed over the years. Our society is more eager to sue and nowadays everything that happens we are made aware of. So we hear about all the malpractice, negligence and wrongful deaths that we wouldn’t have heard about in the past. Patients are no longer kept in the dark. The Patients’ Bill of Rights was first adopted by the American Hospital Association in 1973, and even though it is not a legal binding document it does provide guidance and protection to patients and their families by stating the responsibilities a hospital and its staff have toward them. Upon every hospitalization a patient must be given a copy of the Patient’s Bill of Rights. Before any procedure or test is performed patients must be made fully aware of why the procedure or test is ordered, and what to expect. Next the patient must give their informed consent before any procedure and/or test can be performed. This is required whether the medical service is at a doctor’s office, outpatient x-ray clinic or hospital.

What can be done to help stop medical misconduct?

It’s not only the healthcare provider and facility who hold responsibility for your care. You yourself have a big responsibility as well. It’s up to you to stay involved in your treatment plan. Medical misconduct is a serious offense and the FBI is very much involved in the investigation of cases. If are suspicions about a healthcare provider, institution or if you feel that negligence, abuse, and/or fraud may be involved, don’t sit back and do nothing about it. You can find contact info to report this by accessing the State Fraud and Abuse Reporting Contacts’ site. If you are an employee and have something to report, then don’t hold back. There are whistle blower laws to protect you from retaliation in the workplace. You have no excuse! Don’t be a victim or sit back and allow medical misconduct to continue. You must report it if you witness it, and sincerely want to stop it!

Dr. Geneva M. Edwards
Medical Investigator

Is Medicaid and Medicare fraud real or media hype?

Healthcare Law

Is Medicaid and Medicare fraud real?

Is Medicaid and Medical fraud real or media hype? It sure is a lot of media coverage on Medicaid, Medicare and the fraud involved in their services. It seems like every day we hear about healthcare scams involving illegal Medicaid and/or Medicare claims that were either paid or submitted for payment. However, Medicaid, Medicare fraud is more than media hype. It is quite a reality and costs taxpayers billions of dollars every year. In 2010 the Government Accountability Office (GAO) released a report identifying $48 billion in improper Medicaid, Medicare payments. This is not a new problem and even with task forces in place to strike against healthcare fraud, it still is a growing problem in our society.

In 2007 the U.S. Federal government developed a Medicare Fraud Strike Force. This force was put in effect to determine if businesses in Miami were involved in Medicare fraud. Of the 1600 randomly selected businesses it was determined that more than one third of them (481) didn’t even exist and yet they collected over $237 million dollars from Medicare for equipment charges. In 2010, it is documented that 94 healthcare providers were charged with $251 million dollars in phony Medicare and Medicaid claims, known as phantom payments. Medicare, Medicaid fraud is called an Open Invitation to Fraud and has become so lucrative now that the Russian and Nigerian mobs are involved.

In Florida Medicare fraud is more productive, less dangerous and because of this some New York crime families have relocated there. However, even with that Florida is not listed as one of the top states struggling with Medicare fraud. While every state has its share of Medicaid fraud, the Office of Inspector General lists the following states topping the list: California, Texas, New York, Ohio and Kentucky. In New York where Medicaid fraud has also been a big problem, officials suggest that 40% of Medicaid payments are questionable. For example, several years ago a Brooklyn dentist filed 991 false Medicaid claims in one day.

Nashville is affected as well with Medicare fraud. In 2009, according to the U.S. Attorney’s office, Glenesha Bowling Moye, Tabitha Jones, through their co-owned company, EBC Healthcare pleaded guilty to billing both Medicare and TennCare for services that were either never provided or provided by personnel who were not licensed to do so in the state. As a result, between 2005 and 2007, this couple racked up a total of $1.1 million dollars.

To sum things up we can safely state that on average tax payers lose approximately $100 billion dollars in waste, fraud and abuse in both Medicaid and Medicare programs yearly. The good news is that several states have recovered $1.7 billion in fraudulent payments in 2011. The bad news is that the government had to spend over $208 million in recovery efforts.

What can be done to help stop Medicaid, Medicare fraud?

The government is making every effort to stop Medicare, Medicaid fraud. But the government can’t do it alone. Are you are concerned and want to make a difference? If so there is something you can do about it. If you or anyone you know suspects Medicare or Medicaid fraud there are ways to report it 24 hours a day. Here are a few of the websites available to report Medicaid, Medicare fraud: The Tennessee Bureau of Investigation, the Office of Inspector General, and All of these sites are specifically designed and easily accessible for individuals to report Medicaid, Medicare fraud anonymously. The Center for Medicare and Medicaid Services has even provided an toll free number to report fraud: (800) 447-8477. There are also whistle-blowers’ laws to protect people who report Medicaid, Medicare fraud.

There is no reason now for anyone to sit down and do nothing! It is time for all of us to stand up, play a big part in cracking down on the Medicaid, Medicare fraud dilemma to help reduce the cost of healthcare in the United States.

Dr. Geneva M. Edwards
Medical Investigator

How many preventable deaths occur every year?


What is medical malpractice?

Medical malpractice, also known as medical negligence is defined as a professional negligence by an act or omission by a healthcare professional. The medical treatment falls below the accepted standard of practice in the healthcare community and causes injury or death to the patient. Most cases of medical malpractice involve medical errors.

How many people die preventable deaths from medical malpractice?

In 1999, the Institute of Medicine (IOM) conducted a seminal study of preventable medical errors. They estimated that as many as 98,000 people die every year in the United States. The cost of these deaths is greater than $29 billion dollars. According to the Institute of Medicine, these deaths are nine times more than homicidal deaths and these preventable medical errors would be the sixth leading cause of death in America, if the Centers for Disease Control and Prevention (CDC) were to include preventable medical errors as a category. Unfortunately these deaths have increased over the years. In fact, an editorial released by the New York Times in July 2012 estimated that more than 200,000 deaths every year are caused by preventable medical errors.

Why are there so many medical errors resulting in deaths in our society?

One of the reasons there is an increase in medical errors is that healthcare providers aren’t able to spend enough time with their patients. A physician spends eight to nine minutes at the most with a patient. Another reason maybe that when patients who are admitted to the hospital, they are sometimes discharged home too early. It’s not like it was before, back in the day. Things have changed over the years. Now the provision of healthcare to patients and the stay of hospitalized days for patients are primarily controlled by insurance companies, not healthcare providers. This is quite unfortunate. Also, many hospitals are short-staffed, and this definitely puts an alteration in the provision of quality healthcare.

Examples of medical errors that lead to preventable deaths

  • delayed diagnosis
  • failure to diagnose
  • incompatible blood transfusions
  • incompetent surgery procedures
  • medication errors
  • missed allergies
  • missed diagnosis
  • negligent birth delivery practice
  • omission of required medical procedures

Preventable cases of medical malpractice deaths in Atlanta

In April 2013 an internal audit conducted by the Office of the Inspector General has linked the Atlanta VA Medical Center to three deaths that occurred over the last two years in the mental health service line, secondary to medical mismanagement. To address these concerns, a senate field hearing chaired by Senator Johnny Isakson, was held in Atlanta on August 07, 2013. According to the Atlanta Journal Constitution (AJC) during this hearing, Leslie B Wiggins who recently assumed the position as director of the Atlanta VA Medical Center reported that two VA employees were going to retire, three employees would be reprimanded and the facility is in the process of hiring more employees to provide healthcare service within the mental health service line. Next month a congressional hearing is scheduled to discuss other concerns. This meeting is to be chaired by Representative Jeff Miller, Chairman  House Committee on Veteran Affairs. At this meeting the Atlanta VA Medical Center and three other VA medical centers have been invited to attend to discuss various concerns Miller has about their facility’s provision of healthcare services to veterans.

In December 2012 an attorney in Atlanta filed five malpractice lawsuits against South Fulton Medical Center (that recently joined with Atlanta Medical Center) for the deaths of four babies and the serious injury of a fifth one. These five mothers have stated that the hospital did not provide proper medical care; claiming medical negligence in the provision of the care they provided. These mothers are devastated that they trusted a well-known established medical center with the delivery of their babies. On December 06, 2013 the AJC published an article addressing this situation,  stating: “The suits assert that physicians and other health-care providers failed to recognize the signs of early labor in one case, unnecessarily delayed a cesarean delivery in another and failed to recognize fetal distress for another baby who was born brain dead and died four days later.


The examples of medical errors that lead to preventable deaths and the two actual cases of medical mismanagement resulting in medical malpractice in Atlanta are not conclusive. There are many more types of medical errors that are not mentioned above and quite a few more cases of medical malpractice with lawsuits against hospitals in Atlanta. If your spouse, sibling, relative, and/or if you know someone who believes their loved one died from what may have been medical malpractice, please contact an attorney as soon as possible. In Georgia there are statues of limitations; stipulations to the law that apply to filing a medical malpractice lawsuit. Therefore, you have no time to waste.

All people have the right to receive quality of care at all times and any individual who has lost a loved-one due to medical malpractice needs to be compensated. And it’s not just about monetary gain. If a healthcare provider is responsible for medical malpractice that resulted in death, they need to be held accountable. Your actions will protect other patients and their family members in the future. Atlanta has several attorneys who specialize in medical malpractice lawsuits. As always, the choice is yours!

Dr. Geneva M. Edwards
Medical Investigator

What is Euthanasia? Is it the same as phyisician-assisted suicide?


What is euthanasia? Is it the same as physician suicide?

What is euthanasia? Euthanasia in humans is the induction of death in a person who has a terminal illness. This act is also known as a mercy killing because it is assumed to be committed as an act of compassion; carried out to end suffering and pain. There are various types of euthanasia. There is voluntary, involuntary, active and passive euthanasia. In voluntary euthanasia, the patient consents to have their life ended by a healthcare professional. Involuntary euthanasia occurs without a patient granting consent to end their life. Active euthanasia takes place when a terminally ill patient is given a drug to induce death. In passive euthanasia, the patient’s medical treatment that is sustaining life is terminated. This allows death to occur.

There may be a thin line between euthanasia and assisted-suicide. These two acts are defined differently. In physician-assisted suicide death may not occur without it. In euthanasia, death is always inevitable due to the patient’s terminal illness. A lot of moral issues surround euthanasia and physician-assisted suicide. Many believe that no one ever has the right to end another person’s life. They feel this way regardless of a terminal illness or not. They consider this act unethical. On the other hand many believe if a person suffering  indefinitely is unethical. Especially knowing there is no recovery.

The morals and ethics of euthanasia and physician assisted-suicide provoke crowded emotions. For example, Dr. Jack Kevorkian was an American medical doctor. He was an assisted-suicide activist who was convicted of second degree murder for his direct role in physician-assisted suicide cases. He was looked down upon by people all over the world. Many health professionals looked down on Dr. Kevorkian. There were also many other healthcare professionals who agreed with him. The ones who agreed with him would not come upfront with their support. If they did they would have been scrutinized.

Does a patient have the right to die?

Patients do have rights. The Patient Bill of Rights Act was originally developed in 1973. This act allows every patient to be involved in the provision of their healthcare. In 1992 this act was revised. So it is well-established that patients have rights. The million dollar question is whether or not a patient has the right to die.

In the United States the majority of the states do not have a right to die law. However a few states do have this law and honor it. Several unusual medical cases have contributed to the enactment of the right to die law. As a result, 5 states have passed laws to allow terminally-ill patients the right to die. These patients are competent to give consent to end their life.  Oregon was the first state to pass a constitutional right to die law in 1994. Washington passed a similar law in 2008. Montana passed one in 2009. Vermont passed one in 2013. And recently New Mexico supported the right to die law this month, 2014. These laws are called “death with dignity laws”. Connecticut, Hawaii, Kansas, Massachusetts, New Hampshire and New Jersey have introduced bills similar to the “death with dignity laws”. These states are waiting on supporting house votes  and/or court decisions.

What is an advance directive?

An advance directive is a signed document; granting permission for healthcare provision prior becoming permanently unconscious and/or prior death. This document is provided in advance, and will allow a person to legally accept or reject medical care in the case of an emergency. This advance document is called a living will. If a living will actually states that a person does not want end of life care, it therefore upholds that person’s right to die. All states honor a living will.

Where does Georgia stand with a law that supports euthanasia?

In Atlanta, a top court did not support Georgia’s restriction law of assisted-suicide. The Supreme Court unanimous ruled that restricting assisted suicide is actually a violation of freedom of speech.  As a result, in 2009 four members of the Final Exit Network group who were charged with assisting a fifty-eight year old man to death. This man had a terminal illness. These four did not have to stand trial. No, Georgia does not have a law that forbids assisted-suicide. However, Georgia does have is a law that bans public advertising of assisted-suicide. This law was embraced to prevent the likes of physician-assisted suicides. The acts that were first introduced by Dr. Kevorkian in 1994.

Criminal verdicts in euthanasia acts

Euthanasia and physician-assisted suicides are ongoing. Every individual has a right to agree or not agree with these actions. There are physician-assisted suicide laws all around the world. Just because someone agrees with human euthanasia-type behavior doesn’t mean that they are going to partake in these actions. There are many who may feel they have the right to end the long-suffering of a loved-one, a friend, etc. However, we all know or we should at least know that there are consequences for violating the law. Cases of mercy-killings have manifested in criminal prosecutions in the United States. One example, Charles Cullen, a 43 year old male nurse in New Jersey was charged with killing 2 patients in 2003 by lethal injections. He took it upon himself to make the decision that these patients should die. Cullen admitted to killing 30-40 patients throughout his 16 years as a healthcare professional. However, after a thorough investigation experts determined that Cullen had murdered approximately 400 patients; making him the most prolific serial killer in American history. He may have considered his acts merciful but the law saw things quite differently. Healthcare professionals are not the only ones who get involved in these so called merciful acts. One example of a mercy killing in a lay person occurred in Griffin Georgia, a town 38 miles outside of Atlanta. In this town Carol Carr, a 63 year old mother was prosecuted and convicted for her acts of mercy. In 2003 the state of Georgia sentenced her to 5 years in prison and 5 years’ probation for fatally shooting her adult sons in their nursing home beds. Both of her sons suffered with Huntington’s disease, a terminal illness. She was tired of their long-suffering and decided to take it upon herself to kill them and put them out of their misery. Carol Carr was convicted because she broke the law. She may have believed her act was merciful.  However the law didn’t see things that way and charged her with a double murder.

Listed above are only a couple of cases resulting in criminal charges for mercy killings. In both cases, the law was violated. Take home this message: regardless of whether one agrees or not with euthanasia and/or assisted-suicide, if a law is violated consequences always result.

Dr. Geneva M. Edwards
Medical Investigator


Prescription drug abuse?

What is prescription drug abuse?Prescription drug abuse is the use of prescribed drugs for non-medical reasons. Doctors are prescribing drugs for health reasons more than ever before. Unfortunately, it is estimated that more than 20% of people in the United States use prescription drugs for non-medical reasons. A few examples of prescription drug abuse include taking a friend’s prescribed pain killers to treat your headache, pain, and snorting up or injecting ground up pills to get high. According to the National Institute on Drug Abuse the crisis in prescription drug abuse is among teens in the United States. In fact, a recent survey conducted showed that more than 24% of high school children, approximately 5 million teens abuse prescription drugs. Some of these teens are exposed to prescription drugs in their own home, through their parent’s medicine cabinet. Others may obtain prescription drugs from friends, siblings, older adults, drug dealers, etc.Are prescription drugs legal?Prescription drugs are legal as long as they are ordered by a licensed practitioner as part of an individual’s treatment plan and they remain legal as long as the individual who was prescribed the drug uses them. Prescription drugs become illegal when they are taken in excess to get high, or if they are taken by someone who they were not prescribed for. So if you have a headache and you take a family member’s or friend’s prescribed pain pill, this is considered illegal usage of prescribed drugs.

Frequently abused prescription drugs

Opioids-pain relievers (Oxycodone, Percocet, Lortab, Hydrocodone, Tramadol) Central nervous system depressants-anti anxiety drugs, insomnia drugs (Barbiturates, Xanax, Elavil, Ativan, Ambien, Lexapro) Stimulants-drugs used to treat narcolepsy, obesity (Amphetamine, Ritalin, Adderall, Pemoline)

Prescription drugs are intended for medical purposes only, not recreational use. The problem with prescribed drugs is that they are easily accessible once ordered, are easily addictive and without knowing it an individual can develop tolerance to them. Along with tolerance comes the need for higher dosages, and higher dosages can lead to overdosing which can lead to death. According to the Center for Disease Control and Prevention, one-hundred people die every year from drug overdose.

If you take prescription drugs and are parents, please lock up your prescribed drugs so that you children do not have access to them. And if you feel you may be addicted to prescription drugs or one of your loved ones may be addicted, seek assistance as soon as possible. Nashville is part of the coalition against prescription drug abuse and they have many detox treatment programs available for prescription drug addiction and abuse. If you sit back and do nothing about your addiction you may become a statistic. Reach out for help now and don’t try to do it on your own. Some prescription drugs may be associated with withdrawal symptoms and this is why you need medical guidance to help you overcome your addiction.

Dr. Geneva M. Edwards
Medical Investigator