Spillin Tea Across America: Mississippi

[00:00:00] Welcome back to Credentialing Chronicles, where we spill the tea on the doctors you see. And we're spilling it baby all across America. Well Nyleen and Shannen sitting there talking about you while you pull up a chair. They hold it back to Credentialing Chronicles. I'm Shannon. How are you Miss Beautiful?

[00:00:26] Hi and I'm Nyleen. How are you Shannon? I'm so excited. Getting to an interesting state today. Very interesting. The Magnolia State, the state of blues music, Delta cooking, a little bit of warm hospitality. But apparently healthcare fraud has a business plan down there as well love. See and you know that's the part that no one puts on the tourism brochure.

[00:00:54] No no they don't. I know it's not like one Magnolia Blossom on the brochure says by the way someone is billing Tricare $15,000 in this state for some pain cream. Oh goodness. $15,000 for some cream? Shannon that cream better fix my back, my credit, my shoulders, my knees, my hips. Well and of course every single bad decision I ever made in the 20. Not every bad decision Nyleen. Yeah it's all of them.

[00:01:24] All of it. You're right. You're right. So rub the credentialing file clean while it's at you know it needs to rub all the credentialing files clean while it's at it. So what it did was expose one of the most audacious healthcare fraud ecosystems in the country. And it was all centered on Mississippi's Gulf Coast region. Oh by the water? I didn't know that what I was walking into when I started reading all of this information for this episode.

[00:01:54] Every time I thought okay well that's the scandal. And then of course another licensed doctor, practitioner, clinician walked into the story. Exactly. Mississippi does not make the national healthcare fraud headlines you know that very much. I don't hear it the way that Michigan or Minnesota does. But the stories are there girl. You know, investigating and looking. I mean they are jaw dropping.

[00:02:20] Okay I mean first, you know, let's just talk about the pain cream empire, right? Every state has a different story, but one thing doesn't change. Healthcare organizations across the country are facing increasing pressure to navigate a more complex reimbursement landscape. Whether it's evolving payer policies, managed care challenges, staffing shortages, or just the need to improve your overall financial performance.

[00:02:46] Today's surgical providers are being asked to do more than ever before. In order for you to get some practical assistance, please visit nimble rcm.com and let them know credentialing chronicles thank you. Before we get into it, just a full disclosure, we have not credentialed any of these files. This is all based on publicly reported information and we are not here to give any credentialing advice. We are just here to spill some tea.

[00:03:13] All right, so calling it an empire is not dramatic when you're talking about half a billion dollars. Yeah, I mean, yeah, yeah, I guess 510 million dollars is half a billion. You're right. I didn't even think of it that way. I mean, and this was an operation that had targeted military families, veterans, and their families.

[00:03:36] I mean, Walters literally received you guys 18 years and nearly $290 million in restoration. No, not restoration. What's it called? Restitution. Okay, so we have pain cream, kickbacks, military families, and then of course half a billion dollars before we've even poured the first cup. Nyleen, it's boiling today. It's boiling.

[00:04:02] Oh my goodness. So half a billion dollars in Mississippi is a whole lot of money in Mississippi. That's not somebody just like padding a claim. It has to be like a full industry infrastructure put together, you know, billing fraud, all these things. So to understand the Wade Walters story, I guess for our listeners, and all of the necessary compounding fraud stories we're covering today,

[00:04:26] you really need to understand what compounding pharmacies are and what the billing loophole was that made this fraud even possible. I mean, okay, Shannon. All right. All right. So walk me through a compounding pharmacy. Go ahead. Oh Lord. Well, I mean, I guess a compounding pharmacy, throw me on the spot there, makes custom medications for a specific patient.

[00:04:52] So maybe someone has an allergy, I guess, to like a certain ingredient or needs a dosage that is not commercially available because, you know, we're not all the same human here. Um, it is a legitimate and it is an important part of healthcare that I learned about. Well, that's actually very important because if you can't buy it off the shelf and if it's not commercially available and if it's customized to a person, well then the problem isn't the actual process of compounding, right?

[00:05:19] No, I don't think it is. I think you're right. You know, I think the problem is what happens when a legitimate clinical tool like compounding, right? Meets a reimbursement formula that can actually be manipulated. What do you think? Yeah. Yeah, for sure. And somebody probably looked at those differences and that customization and just saw, well, I could probably make some extra money off of this. Yeah, I think you're right. I think you're right. And a whole lot of dollar signs were made. A whole lot of dollar signs, I mean.

[00:05:47] Right, because then the compounded drugs don't really go through the same FDA approval process that like a counter medication would. I mean, it would seem that way. And you know, before 2015, TRICARE, you guys, reimbursed compounding pharmacies for each separate ingredient. And so the more ingredients, what did that mean?

[00:06:09] Oh my goodness. So wait a minute. So the formula rewarded complexity, whether the patient needed that complexity or not, like the fancier they made the medication, then the more they got for it. Nyleen, Nyleen. Exactly. Exactly. Load the cream with high priced ingredients and the claim keeps what? Suviendo, climbing, climbing, climbing. So one month's supply could be billed, Nyleen, at $15,000.

[00:06:38] And you're getting called for braces and they're charging $15,000 for pain cream, Nyleen. That's crazy. So the patient thinks, oh, I really need this medication. The doctor prescribed it to me. So it must be necessary. That, you know, that makes me think, you know, not for nothing, but my daughter had a wart one time. And that wart medication from the compounding pharmacy was like $150.

[00:07:05] So I could see how that's a lot. Doing scheming afterwards, I said, I think I just got scammed. I think they added a couple of extra things in that cream. I think you're right. I think you're right. And, you know, in 2019, a study found that these creams worked no better, Nyleen, than creams with no medicines in them. But that's what happened to my daughter. Yeah. So that's why we're not talking about like an expensive miracle cream.

[00:07:33] And girl, that's like, you know, you know, some of that, the Chinese cream, we work in better sometimes than some of that other cream. And you get off of the, with the little tiger on it, the tiger. Yeah. Yeah. The Korea green or something. So we're talking about an expensive audacity in a jar, in a jar. They were billing $15,000 for a cream that didn't even work. For a cream that scientific study found work no better than a plain old cameraman lotion.

[00:07:59] No. And Wade Walters, honey, this was out of Hattiesburg, Mississippi. He's a businessman who co-owned multiple coal-pounding pharmacies. Like that's what he did. And he also owned pharmaceutical distributors. And he turned these into literally the largest healthcare fraud scheme in Mississippi history. And this just happened. This is not like five years ago. Like this is current. So then how did he build it?

[00:08:29] Like, how did he make this happen? Oh my God. From all the research, you know, really quick rundown. From 2012 until 2016, Walters and his co-conspirators adjusted formulas for the highest reimbursements, Nyleen. Not for the best treatments, like you said. And then they hired recruiters to bring in TRICARE beneficiaries and build literal commissions tied to those reimbursements. Talk about sophistication. That's crazy.

[00:08:56] So for the credentialing people out there or for anybody that really wants to learn. So not only was it a Medicare fraud and a waste, you know, violates the fraud and abuse waste. It's also an anti-kickback violation because people are getting kickbacks for all of this. So let's translate that. So you're going to find the patient, build the most expensive cream possible, and then keep a cut of whatever gets paid.

[00:09:25] I mean, doesn't that just sound like fraud? Exactly. Exactly what you're saying. But the machine still needed a prescription. Of course. You need a doctor, of course. And that is where the physicians, the nurse practitioners, and the other licensed providers entered the door. Kickbacks, like you said, were being literally paid for authorizations. And sometimes for patients, the providers had never literally examined. And there it is. The clinical signature just being used as a payment code.

[00:09:54] And the credential made the claim look legitimate every time. So you're telling me they were paying doctors to sign prescriptions for patients they'd never seen? Never seen. Patients not examined one time. Medicines literally not medically necessary. And copayments routinely waived so that beneficiaries had no financial reason to say no. You know that that's illegal? That's illegal. You're not allowed to waive copays or deductibles.

[00:10:23] It's crazy. And they even created a fake copayment assistant program, because they're so helpful, to make the waiver look legitimate. Yes. So did you know the only legal loophole, actually, and please do not do this in your practice if you can avoid it. The only legal loophole is if you say that the patient cannot financially pay for it, then you can waive that.

[00:10:49] So for all of you listeners out there that are in a practice or even as a patient, you should have to fill out a financial affidavit that you cannot afford that coinsurance or that copay. So that's really interesting that you're telling me they created an entire program over this so that they can just go ahead and not take whatever, you know, they got from that medication. So it tells me that they understood the rules well enough to actually build the camouflage around breaking them. Expert tricksters.

[00:11:18] Expert tricksters, right? Okay, so this was not sloppy, like you're saying. I mean, you're not even, your name's not even Inspector Gadget, okay? And you can see that it was not sloppy. So remove the copay. More people accept the cream. More creams mean more claims. And more claims mean what? More money, of course. And then the patient, yeah, and the patient may never even realize that their name is just becoming like inventory. I mean, how much money are we talking about the losses?

[00:11:48] I know we talked about half a billion, but tell me about the losses. Before we talk about that and the doctors don't realize that they signed off on 150 creams. That's crazy. You know what I'm saying? But yeah, I mean, we get back to the money. Total losses, they said, exceeded 510 million. Walters himself, the guy that owned everything, his portion accounted for 287 million. And he personally, personally had 56.5 million.

[00:12:19] 56 and a half million dollars from a cream. And you know, cream is actually really smart because it's not like a pill where you could get like side effects, you know? And people want to stop taking it. But creams don't really like how much harm can you get from a cream, right? You're right. Maybe now I'm sure that went into the business plan as well. And here is a number that should really make every compliance person, everyone that's listening, you guys, sit straight up.

[00:12:47] Compounding prescriptions were only one half of 1% of TRICARE prescriptions, but 20% of its cost. Wow, that's not a red flag. That's like a red billboard with like flashing lights all around it. Yes. You know, I'm telling you, they need to put me and you in charge of some billing compliance because we would be co-running it all.

[00:13:10] I mean, TRICARE, you guys, ultimately had to seek emergency supplemental funding from Congress because of the scheme. It tore such a hole in their budget, you guys, because they are just considerably paying out these cream bills. Oh my goodness. So that means taxpayers are paying twice, once for the fraud claims and then again to repair the damage? So what ended up happening to this business guy? Girl, he was charged on 37 counts in September 2019.

[00:13:39] He pleaded guilty in July 2020 to one count of conspiracy to commit health care fraud and one count of conspiracy to commit money laundering. At sentencing in January 2021, the U.S. juristic judge who called this case probably the largest fraud case he had ever tried in the state of Mississippi, sentenced Mr. Walters to 18 years in federal prison. You know, the cushy kind.

[00:14:05] Two 108-month consecutive terms, one on each count. So ultimately, he was ordered to pay $287 million in restitution. But he only made $56 million. Well, he was ordered to forfeit the $56 million. So he had to get that back. Oh my goodness. Because that was his personal money. That wasn't the business. And at sentencing, Walters' girl had told the court, By then, the stakes were too high.

[00:14:35] I thought I should get out of it. I regret, this is his quote, that I didn't see that right away. I'm tired. I'm ready to move on and serve my time. So he knew it was wrong the whole time and then just kept it going anyway, hoping he was never going to get caught. Guilty conscience was tired, honey. He said he's going to get some rest in jail. I know that's right. I mean, you're right. He was wrong and he kept going, Eileen. You know, and Walters was not operating alone, of course, right? I mean, there's, you know, pharmacists.

[00:15:05] You had talked about the doctors and the licensed nurse practitioners and all of that. Yes. The pharmacist separately pleaded guilty that one of his big pharmacist schemes involving at least $192 million. Nurse practitioners, clinic owner, her received 42 months for prescriptions issued to patients she had never examined. Tied to $1.37 million in fraudulent TRICARE claims.

[00:15:33] The doctor's claims were less than what their cream claims were. Oh my goodness. So every time they pulled one thread, then another licensed professional just happened to be attached to it. Yes. Two doctors and two registered nurses were indicted in a scheme involving medically unnecessary compounded medications, included ketamine and more than $7 million in reimbursements. That's crazy. So same region, same playbook, just different names.

[00:16:01] So let's talk about a little bit about the credentialing angle. So, but, and what does, and how does credentialing play into all of this? And obviously, remember we did, we have deciphered the difference between the two terminologies of credentialing, meaning like privileging and then credentialing, which is the billing side of things. But, so what does this ecosystem mean for credentialing angle? Talk about it. You know about it. Like it's the kickback stuff you were talking about. Talk about it because literally. Right.

[00:16:29] So kickbacks paid to physicians that, you know, they were authorized for patients that they never even examined. Again, I got talked about is the violation of the anti-kickback statute and medical licensing standards that exist. So when a doctor signs a prescription for a patient that they have not examined, they're not practicing medicine because remember these doctors were getting a kickback because if they had to pay back millions of dollars, right? They're operating, like selling of their signature.

[00:16:58] So that's a conduct that's like bad, you know, bad behavior. And then if it services in a credentialing review or if we are auditing any billing practices, it's really grounds for disciplinary action, privilege restriction or MPDB reporting, all kinds of things. I mean, you could lose your enrollment with these insurance companies if they do an audit.

[00:17:23] You know, even, even, you know, I always talk about what happens in my life because Lord knows every day I have another story. But I even got a report from one of the insurance companies saying that we were billing too many this level versus another level. And they want us to start downplaying the levels because I'm like, how long did it take for them to do an audit to say all of these same prescriptions over and over and over and over again? Yeah, I mean, everything stays invisible until somebody starts looking into it, right?

[00:17:51] Of course, it's going to stay invisible if credentialing and quality and claims and fraud teams and never compare the notes. Prescriptions are going to spike one drug, one pharmacy. So it's like everybody's in on it. It has to make like somebody see it. And I guess like, you know, you talk to a lot of credentialing leaders. So like what is something that you would say to credentialing leaders?

[00:18:15] Well, I would say that we really have to start working as part of the reappointment cycle with our revenue cycle teams. It may not be your department, but it's your provider, your doctor. And if someone goes from ordinary prescribing, right? So then all of a sudden these $15,000 creams and somehow every single patient needs it or just so happens that everyone who has TRICARE is allowed to have that prescription. Then there's a pattern that exists. And this goes down to the private practices.

[00:18:44] If you're an office manager, like what is your doctor prescribing? How is it working in your system? And are you auditing these things? Yeah. I mean, that's when, you know, we really talk about monitoring and, you know, people want to keep monitoring in a box. Remember, it was just monitoring license, you know, and then it was just monitoring DEA and then we're monitoring liability insurance. And now we're monitoring sanctions and we're monitoring OIG, you know, and so like monitoring keeps growing, you know, and I get that. But it can't be like sanctions, checks, license and a prayer.

[00:19:13] I mean, it really needs to be like things need to start really getting monitored claims, connect the dots, the conduct, the patterns, right? I mean, do you agree? Yes. Yes. Yes. And I think that when we, there's a reason why, when we do ongoing review, it involves not only just did you kill anybody in the last, you know, two years or three years? It's like, what was your behavior?

[00:19:38] And I really think that revenue cycle should start playing a role when we do these case log reviews. Yeah. It has to be all together. So because the data was there, the question is whether or not anyone was looking. Oh, that's good. Yeah, you're right. And the data is almost always there. Like we say, the fraud enforcement answer, you know, is always like really quick, you know, prosecution. But credentialing's answer should be proactive monitoring.

[00:20:06] And that's, again, what credentialing chronicles is advocating for in all of our stories, because, you know, the monitoring matters, you all. Okay. So we just have to switch it because, you know, everything is just crazy, but we're going to talk about a story right now. Yes. So I'll give you my story, which is seven days without insulin girl about a nurse and a jail. Because, you know, I love all the jail stuff. You love anything crime.

[00:20:36] And I should have been like a detective or something. Yeah, yeah. In your other life. Which that's why credentialing, I always said I was a private investigator. But anyway, so story number two is different in the scale of what we're talking about. And not because it's not as important. But the story is about a nurse, a patient, and a death. A death that was entirely preventable.

[00:21:00] And it ends with a criminal conviction that should fundamentally change how organizations think about healthcare credentialing in correctional settings. Correctional. Correctional. Okay. Okay. So, okay. Well, now you're setting the scene. So I'm getting it. Okay. Tell me. Okay. So we're in a county called George County, Mississippi. And it's September 2014. We got a 29-year-old man. And he is incarcerated. So poor guy. Life's a little tough.

[00:21:30] We're at the regional correctional facility. He's suffering. But this person is insulin dependent. So that means he's a diabetic, right? Who requires insulin to survive. We all know that, right? And seven days. He goes seven days and did not receive any insulin. What? So what do you think happens after seven days, Shannon? Tell me. I don't know. I was just thinking seven days. I was like, was he eating?

[00:22:00] You know, I had so many questions. You know, I mean, was he feeling anything? What is he saying? Did he let them know? Right. So this poor man, he couldn't breathe. He felt weak. He couldn't keep food or liquid down. Guards end up finding him on the floor, unable to walk more than once. Like, we're talking about more than once. Like, what? You didn't flag it the first time you found them passed out? And that's not subtle. Like, that's not like, oh, maybe something's wrong with him, right?

[00:22:30] Yeah. You know, I mean, is there a checklist, Nyleen? Like, can he walk? So you know what that's called? So it's called diabetic ketoacidosis. And it's actually considered a medical emergency. Because without treatment, it can be fatal. Which basically means if you're a diabetic and you are not producing your insulin, you need insulin. So and then if you don't treat that, then you die.

[00:22:57] And so this poor man ended up dying on September 14, 2014. And that's, I guess, where all the joking stops, right? Because this was literally, I mean, like you said, he was 29 years old asking for help in a place where he could not go out to Walgreens and get any help. Yes. So there was a nurse in charge. And this nurse was at the jail.

[00:23:19] And according to the testimony at her trial, the nurse accused the patient of faking his symptoms. Girl, she said, you're making it up. She denied him treatment because she said, oh, you over-exaggerating. She signed a, yes, yes, signed a refusal form, which the defense leader pointed out too.

[00:23:45] But prosecutors argued that her signature, that the signature on the refusal form does not discharge a medical professional's duty to provide necessary care to a patient who is visibly deteriorating and could not make a competent medical decision due to his condition. Nyleen, so if you are diabetic, it's a simple, it's a simple prick. Right? I mean, you know, she could have done that. Like, what happened in court? Because I feel like she could have at least tested the blood.

[00:24:14] Great, because she's making up the fact that he signed a form and all this other stuff. But it's like, you see the guys passed out on the floor. Like, your job as a nurse is to provide medical attention. So, long story short, nurse was tried and convicted of manslaughter. She sure was. Yes, 2018, the trial had to be moved out of the county due to... Pre-trial publicity. Of course, everybody in the media is eating this up.

[00:24:40] So, she was actually sentenced to a girl 15 years in prison. Lost it. Yep. And the Mississippi Court of Appeals affirmed the manslaughter conviction in 2020. Yes. Then the Supreme Court, it went all the way up to the Supreme Court that declined to hear the case in June of 2021. Oh, they didn't want to hear it? No. In 2022, the county agreed to $2.8 million in a civil settlement. To pay his family? Yes.

[00:25:10] So, a figure that actually represented roughly half of the entire annual budget of the entire county. Yes. And girl, 10 settlements in the last five years involving Mississippi jail deaths. So, you're talking that this is happening across jails in Mississippi. Y'all, there's something happening. If you're listening to this, y'all, somebody go down a rabbit hole, comment, share, let us know. We want to know what's going on.

[00:25:40] I mean, this is crazy. And you know, they say in the South, they still have like plantations and slave labor. Oh, my God. But something's happening, y'all. It's not remotely. I mean, that's 17 people who have died in Mississippi state custody from diabetes. Are they all from diabetes? Yes. Well, it says just in diabetes causes since 2015. Yes. Yes. But that number doesn't include the other kinds of deaths.

[00:26:09] The other kinds of deaths. Yes. Guess what? You want to know why? Because Mississippi apparently has no state law requiring local jails to track and report in custody deaths. What? So, yeah, this is actually a systemic gap. There's a project called the Marshall Project reported in 2025 that Mississippi acknowledged

[00:26:33] its local jail death data is largely absent from federal reporting requirements. So, what we know about who dies in Mississippi jails and why is actually far less complete than what we should actually know. I mean, you guys, that is a comment below. Is that okay? Do not get arrested in Mississippi. Okay? I mean, right? If you're going through Mississippi, get in and get out. I know.

[00:27:02] So, let's talk a little bit about the credentialing failures here. Now, in credentialing, we don't necessarily credential nurses, but there has to be a medical director, right? So, you tell me. What do you think about it? Yeah, yeah. I mean, there are at least two, right? You know, the lady that you were talking about was employed as a nurse at the jail and then the county jail is a healthcare setting, a nurse providing care in a county jail, managing what?

[00:27:33] Medications, responding to medical emergencies, I guess, when she wants to, right? Assessing patients. I mean, is practicing nursing. And nursing practice requires that certain conditions you all be met for safety practice, including appropriate supervision for licensed practical nurses and adequate staffing ratio to manage a caseload safely. Oh, and she was, so she was an LPN. She was a licensed practical nurse. She was an LPN. Yes.

[00:28:02] And, you know, the LPNs, they try to use them just because they are, you know, lower costing than an RN. And, you know, but the LPNs practice requires supervision, you all, by an RN. So even though you want to use them, you still got to bring in an RN to look over everything or a doctor. So if you, I guess if you have a doctor on staff, you could, you know, use the doctor too. Her defense argued though, that she was responsible, right?

[00:28:29] For 300 to 400 inmates that had begged for more nursing staff. Wow. So I can hold two truths. So that workload really sounds unsafe. I mean, at a hospital, you're talking about five to six person ratio is average. It still does not excuse ignoring a medical emergency for seven days of someone actually passing out. Like, oh, I have a headache. You know, definitely is going to go on a different level than I'm passed out on the floor and can't eat.

[00:28:59] Yeah. And I guess that's why I'm really happy. Like you said, that the court rejected it as a defense, you know, I mean, credentialing and governance still has to be asked though, when we're looking at this, who approved one LPN for that population? Who thought that was safe? Who was the supervising RN, you guys, or the supervising physician overseeing the medical program? Who reviewed whether the staffing model was clinically possible? Right.

[00:29:25] So she was overwhelmed is not only an individual explanation. It may be also an organizational confession. So my question to you is, what do you think is the answer? Well, if I was their consultant, I would probably, you know, look at the separate report from that Marshall project, right? That identified at the same facility, Jones County Jail, same region, a licensed practicum nurse

[00:29:53] was providing care without the supervision required by the license. So now we're looking at multiple Mississippi County jails operating with minimal medical staffing and the oversight of those medical staff members through licensing board is largely reactive. Complaints come in, investigations happen, but no one is literally proactively verifying that the nurses working in these county jails are operating under proper supervision structures.

[00:30:22] And the nursing board has no disciplinary history on the one lady, Carol, the LPN at that Jones County. And despite all allegations of inadequate care, the complaint system only works if complaints are filed and then investigated. But when we're looking at that, they're hiring these LPNs to try to save money. But it's like, why not just hire an RN and allow her to do it? I know. And even, but even one RN can't handle 300 people.

[00:30:51] No, one RN can't, but at least you're getting a higher level of, you know, I mean, come on. It's just all about the money, right? I know. I know. Well, the second credentialing failure, and I'll just talk a little bit about the, that is really contracting, right? Of healthcare vendors in correctional settings. Because a lot of the times what they do in these jails is they actually contract outside healthcare companies, right? To provide the staff. Yes.

[00:31:20] To provide the staff. So they're not actually like employees of the jail, you know, like a lot of hospitals, like they'll contract out cleaning services or your food people. So same thing. If the county hires a contract medical company, that company is responsible for the credentialing of the nurses, the HR paperwork and other providers that they place. So those placements need to go through that same verification process as any other healthcare provider, because you have to at least verify they have an active license. They don't have any sanctions.

[00:31:47] Their scope of practice, of course, is appropriate for what they're actually doing, that their supervision requirements are met. So that OPN should not be working without supervision. And of course, of course, of course, have to have a background check completed. So if a contract company is placing an LPN in these settings without confirming appropriate supervisory structures, right? Or is not providing the assistance and the additional staff that is needed in the county

[00:32:15] buying the contract doesn't even know it because they're just leaving it to this company to say, make sure you provide me enough staffing. And of course, it's the inmates who pay the price or our patients in this case, right? The inmates that are sick. No, I think you're completely right. Oh, my God. Okay. We just need to move on. I mean, I'm just saying, if y'all just really need some help, contact me or Nylee, because we'd be willing to consult with y'all and really help because these things out here in Mississippi,

[00:32:41] I know we work with the Department of Corrections in Colorado. AQC does. And so, you know, if you get arrested in Colorado, believe me, them doctors have been all verified, y'all. I know. Okay. They do a couple of other states too, but Colorado is one of their biggest ones. So I guess because here's the thing, right? When we're talking about, you know, I guess, you know, Walter's going to prison, you know, with the compounding pharmacy fraud.

[00:33:10] And then, you know, that kind of just leads into the ecosystem of Mississippi, which we're thinking. It has been running for years with multiple licensed healthcare providers embedded in it. And those providers had had their own licensing and credentialing processes that were supposed to catch misconduct, right? Every state has a different story, but one thing doesn't change. Healthcare organizations across the country are facing increasing pressure to navigate a more complex reimbursement landscape.

[00:33:39] Whether it's evolving payer policies, managed care challenges, staffing shortages, or just the need to improve your overall financial performance, today's surgical providers are being asked to do more than ever before. In order for you to get some practical assistance, please visit nimble rcm.com and let them know credentialing chronicles saying. Let's talk about some of those providers, you know, Nylee, because it's not just like Walters and the other lady.

[00:34:09] I mean, there's crazy stuff. Oh, there's more. There's always more. Right. So this other doctor is a masterclass in what happens when the criminal case and then licensing response don't line up. Prosecutors connected an even broader compounding scheme in Mississippi to a national one.

[00:34:33] And then this doctor pleaded guilty to a federal charge involving failure to disclose information about the expensive pain cream. Oh my God. Another one for him. So he got a misdemeanor. That one word changes what may show up, I guess, downstream, doesn't it? I mean, it can. He ended up receiving five years of probation, $20,000 fine, and then $116,000 in restitution. But he didn't get prison time.

[00:35:01] And if someone only sees active license, y'all, and moves on, the file can look cleaner than, you know, it is. And that's why we always advocate for background checks, right? That's true. That's why background checks are so important because he was charged with a misdemeanor, not a felony. His specific guilty plea was to a single misdemeanor count of failure to disclose information, which that's why we have disclosure questions.

[00:35:27] He did not face the health care fraud charges that the others in the broader scheme faced. But at the sentencing, he said, according to the reporting agency, I realized I made mistakes in the past and I'm really sorry. I will work harder than ever to be a better person. And from a criminal justice standpoint, that was the resolution. And what about his medical license? I mean, at this point, I'm just like, oh.

[00:35:54] Well, this is where credentialing professionals need to pay attention. When a doctor, okay, pleads guilty to a federal misdemeanor. Misdemeanor now, not a felony, then, and not a direct health care fraud conviction. The reporting obligations to the state licensing board and from the licensing board to the NPDB depend heavily on the actual specifics of the offense. Okay.

[00:36:25] Okay. So a misdemeanor conviction for failure to disclose information is not the same category as automatic reporting trigger as a felony health care fraud conviction. So y'all read your disclosure questions and see if you have felony or misdemeanor, right? And if the licensing board does not take independent action, if the board determines maybe that the misdemeanor doesn't rise to the level requiring discipline under the state law, then technically

[00:36:55] a physician with that conviction could continue practicing with a clean looking license. So he could still be credentialed by a health plan or a hospital is pretty much what you're saying. Right. And that is kind of a gap because the NPDB receives reports from certain sources like malpractice payers and hospitals that take privilege actions. And of course, any state licensing that takes a formal action. So what happens if the board doesn't act? And technically that wouldn't trigger anything.

[00:37:25] And so a misdemeanor plea may not automatically trigger an action depending on that specific state statute. The NPDB report may actually never be filed and a health plan or a hospital doing primary source verification would just see an active unrestricted license. So if you're not doing background checks, you would never know. Man, Nyleen. And so like, I guess a lot of people might be asking right now, what does Mississippi state law require, right?

[00:37:51] Well, according to the Mississippi code, all right, you want to be technical, 73-25-87. I love it when you tell me state code. Well, that outlines the grounds for disciplinary action by the Board of Medical Licensure for all of you that want to go find out. They include conviction of a crime related to the practice of medicine, but the specifics matter.

[00:38:17] So a felony conviction is a clear ground, and that's kind of really a clear ground everywhere. However, a misdemeanor related to healthcare fraud may be interpreted differently because the board actually has discretion. And discretion exercised inconsistently can create gap, you know, and that's the problem is you're leaving it up to decision. So things could happen where that doesn't get reported.

[00:38:47] Yeah. And that's how you get the good old boy club, right? Because when a board has discretion and then the discretion is exercised, like you said, inconsistently, you know, Bob gets one treatment and, you know, Tyrone gets another treatment. I mean, let's be honest, right? Then there are, it leaves huge gaps. Okay. I think we should talk about our PSA today. What do you think? Yes. Let's go to our PSA. So, all right.

[00:39:13] First of all, doctors, if you're a doctor, please don't, don't sign a prescription without seeing a patient. I mean, really don't do that. Protect your license, protect your MPIs, protect where you're working and who's touching your files because the reality is your license is very valuable and we don't want you to get caught up in a scheme. And whenever somebody is giving you a kickback of something, just, you know, that it's not

[00:39:42] unfortunately can do it. I'm not saying that, you know, people in other industries don't get kickbacks and I know that it may not be fair sometimes for you to help somebody out and get remuneration for it, but it's against the law. So please protect yourselves. I think that's very important to remember, you know, and then if we're talking about patients, again, verify, add a Google alert. You know, we're trying to hope be the catalyst that people listen to us and say, oh my God,

[00:40:12] we really should be doing background checks. Oh my God, we really should strengthen our disclosure questions. Oh my God. And so, you know, because doing those things on the back end would eventually, you know, oh my God, let's not be inconsistent in decision making. That would help patients be able to have a more transparent view into their doctor they're about to see. And that's what we advocate for. But again, you know, doing some of these Google alerts, verifying the license, talk to people, look up reviews online.

[00:40:40] Just really try to do as much due diligence as you can before you go and see that doctor. MSPs, what would you tell them are beautiful MSPs? Learn to state statute because apparently Mississippi, you're not reporting everything that they've done. So go look at what if you need federal or misdemeanor, check your disclosure questions. Make sure it does include misdemeanors and that we are disclosing that.

[00:41:05] And if you are working in the correctional health system or for a health group that provides medical personnel for the incarcerated, please know they are patients too. And they deserve the same healthcare respect, I guess, and level of professional care that we can. We can't just put them aside because of that.

[00:41:33] And regardless of how you feel about incarcerated people, they are humans. And a lot of times it's humans who just have been made mistakes and the healthcare should be provided by appropriately licensed personnel. Yeah. And I would also say like, I guess to LPNs and RNs, right? You know, if you see that like you're an LPN and your organization is placing you into a situation that you feel like is not safe for you or you're overwhelmed or the system's

[00:42:03] overwhelmed, speak up, like go home, write a letter to the government, write a letter to the warden. You know, I understand that that might be crazy. But again, speaking up is the only way that we change systems. And we just can't like show up until what? 350 patients are having problems and you've now been the, you're the center of the problem. You don't want to be the problem when it's the problem is so much bigger than you, because babe, you're the one that they're going to take the scapegoat out on.

[00:42:32] And most importantly, if you're an MSP, make sure you listen, subscribe and follow, share your opinions, react to our opinions. We are on all the platforms. Take a minute to just subscribe and download and tell a friend. If you want an explanation of what we do, this is what we've come across. And we are just here to girls trying to inform you and keep up to date and keep you up to date and let you know that what you do matters every day. So please stay credentialed and not. Canceled.

[00:43:01] Oh, Shannon, that was a lot of tea. Honey, but have they subscribed yet to hear it next week on all of these platforms? Please subscribe, like, and follow us.