Virginia doctor has medical license suspended for Composing fake prescriptions

A physician who practiced emergency medicine at Franklin has had his license suspended by the Virginia Board of Medicine for composing prescriptions that were bogus.

Dr. James Joseph Crouch, who’s recorded by the board using a Virginia Beach speech, had his license suspended Feb. 15, pending a full hearing.  

The prescriptions, that comprised Adderall, Percocet and Viagra, were to get a girl the board investigator explained as with a previous “intimate and/or sexual” relationship with the physician, but maybe not a doctor-patient connection. He also had her fill meds to return.  

Federal court records in Norfolk show Couch made a plea arrangement on Dec. 5 to fraudulently obtaining medications, admitting he used other doctors’ prescription pads and forged their signatures last August and September.  

He’s scheduled to be sentenced in federal court on March 12.  

Crouch’s lawyer, James Broccoletti, said he and his client wouldn’t be commenting about the instance.

Court records indicate Crouch was working at the emergency section of Southampton Memorial Hospital at Franklin and utilized the prescription pads of additional emergency doctors to produce the fraudulent prescriptions without their knowledge.

“The defendant stipulates and agrees that his status as a physician made it considerably easier for him to tackle the prescription fraud explained herein,” read a statement of facts signed by Crouch and his attorney and filed in federal court.

A spokeswoman for the hospital said he didn’t work for the hospital, but rather to get a doctor providers bureau.

Percocet is a new the opioid oxycodone, Adderall is accountable for attention deficit hyperactivity disorder, and Viagra can be used for erectile dysfunction.  

The committee of medicine records show that Crouch had a legitimate prescription for Adderall, but that he had been seeking large doses. The document also said the physician needs monitoring and treatment to opioids, alcohol and other medications.


Indian-American Physician Bunch indicted for performing unnecessary medical tests

An Indian-American physician couple was indicted on charges of committing healthcare fraud by executing unnecessary medical tests and procedures for patients to get payouts from insurance providers.

Dr Ashis K Rakhit, 65, and his wife Jayati Gupta Rakhit, 56, specialise in cardiovascular disease and internal medication and headquartered in Cleveland, Ohio.

According to the indictment, the Rakhits arranged and performed unnecessary clinical evaluations between 2011 and 2018, such as unnecessary nuclear stress tests, cardiac catheterizations, bone density scans, echocardiograms, EKGs, carotid artery tests, lymph ultrasounds of their thighs and abdominal ultrasounds.

They also listed false symptoms in individual records to justify medically unnecessary tests on patients, such as shortness of breath, palpitations, hypertension and abnormalities of breathing, according to the indictment.

The Rakhits charged Medicare, Medicaid and private insurance companies with codes that are inflated to reflect a ceremony more costly than that which was actually done, according to the indictment.

The Rakhits also intentionally dispersed and dispensed controlled substances away from the usual course of medical practice.

Ashis Rakhit is charged by dispersing Percocet and Xanax at 2017, whereas Jayati Rakhit is charged by dispersing Tramadol, according to the indictment.

“This bunch violated the trust of the patients, the citizens and the community,” US lawyer Justin E Herdman said.

“They performed unnecessary medical tests and charged for services that they did not really provide in exchange for prescription drugs – all this in a time in which our area is inundated in fatalities and addiction,” he explained.

“Not only did these doctors put their patients via unnecessary medical procedures so they could line their pockets with extra income, but they additionally prescribed controlled narcotics which were not medically needed,” said FBI special agent responsible for Stephen D Anthony.


Kaiser Permanente Discusses Their Diabetes Care

Since we love to gripe about healthcare providers, but seldom get an opportunity to talk together frankly, I was excited to finally run into a few executives from Kaiser Permanente (KP) at a healthcare blogging occasion.   Enjoy ’em or hate ’em, Kaiser is America’s leading integrated health care company with a distinctive nonprofit business model (and also those cool “your-couch-is-a-carb” / / Thrive advertisements).

They are extremely interested in Social Media, therefore it didn’t take too much coercion to make them agree to a interview with one of their most articulate (and pragmatic) leaders. Dr. Michael Mustille serves as “Associate Executive Director, External Relations.” An extremely major PR title. However, Dr. Mustille is likewise an occupational medicine doctor with 33 years’ expertise and former manager of the South San Francisco KP health centre. He now sits at the executive director of the Permanente Federation, the organization’s medical arm, and can be personally involved in rather a range of health quality initiatives.

Oh, the irony!  Of course I conducted this interview before last week allegations of mismanagement and medical misconduct hit the fan.

Anyhoo, here is what Dr. Mustille needed to say about what he believes makes Kaiser powerful and how this impacts individuals with diabetes.

*     *     *

DM) Kaiser has been pioneering in best practices for chronic disease control, even launching the subsidiary KP Healthy Solutions to let their expertise. What exactly does KP actually do so well here for diabetes patients particularly?

MM) Why is Kaiser is such a leader in healthcare? I’d say it is all about Quality of Care. We’ve shown this consistently, and within the previous decades two things stand out: our treatment for chronic conditions and also our “health & wellness” push to find the greatest possible prevention and screening.

This is in fact substantiated using standardized quality performance measures, such as those from the NCQA, that monitors quality health and certifies health plans/HMOs throughout the country. They use a standardized data set, and also a publicly available rating methodology. (You can look up report cards on almost any HMO in america.) Kaiser is at or near the top round the Nation.

These standards include, by way of instance, a bundle of diabetes-related steps for individuals: Can you get your A1c tested? Your lipids tested? Your microalbumin measured?   We do occasionally examine patients, but we track the quality of care received from our recordings, including claims data and chart reviews.

Obviously, quantifying in these ways is not the same as making people healthy inside their daily lives. For this, we are in need of a coordinated application of actions/treatments which help get patients where they have to be health-wise — in this instance, if they have pre-diabetes, full diabetes, or complications of diabetes have established in.

DM) How simple is it for diabetes patients with Kaiser to get their own “diabetes care team” — endocrinologist, CDE, nutritionist, podiatrist, etc. — to actually communicate and work together?

MM) One big benefit is shared medical documents. At Kaiser, all those people today work in the same organization, usually at the same location. In a less coordinated system, your providers are across town and each has their own medical documents — that are incomplete, because they only demonstrate the care you received at that office. KP providers work shoulder-to-shoulder with the same records, measuring real outcomes.

We cure 277,000 patients throughout the country with diabetes (out of 8.5 million KP members complete). We all know that their A1c, whether have observed the doctor or where in the hospital recently, and if they’ve filled their diabetes prescriptions. We can tell who they are, where they are, and what degree of control they have, therefore we really know what works concerning team care.

We’re making a real effort now to further advance health information technologies with a brand new suite of software programs called KP HealthConnect(Editor’s note: that has also come under scrutiny). Everything significant for each member is recorded digitally, including visits, lab results, prescriptions, etc.,– no more paper records. The information could be shared with any KP provider anywhere.

We’d also like to see interoperability outside of the KP system, therefore emergency teams along with other critical providers possess some way to retrieve and transmit vital patient information. We’re engaging in a national effort to nurture the Interoperability of Medical Records.

DM) Isn’t Kaiser helping establish standards for transfer of data from many different kinds of health tracking systems (that the Continua Health Alliance)? What are a few of the roadblocks or hot buttons there?

MM) Yes, this is a different problem, which is how to create medical devices “speak to one another. “Kaiser is a charter member of their Continua standards committee. The focus is on Home Monitoring Devices — scales, sugar monitoring, blood pressure apparatus etc — would link mechanically with each other to some degree and also to a database at your supplier’s site.

We’re proficient at designing systems which seem strong, but are siloed, meaning they work great only in the range of their wants, but don’t contribute to your overall medical care. A lot of new apparatus beg the question: Is this really beneficial? Or simply confusing, and possibly even dangerous?

These systems are very fresh, and people tend to lump numerous different monitoring technologies together.   What is their value, and for whom?   These questions will need to be answered by doing a few studies.

DM) What about going into continuous glucose monitoring (CGM) because the quality of diabetes treatment? Where does Kaiser stand on this particular issue?

MM) One of the nice things about practicing medicine in KP is the fact that if you’ve got a excellent idea on how best to help individuals, you can go ahead and try it out. A few of our endocrinologists in Southern California recognized CGM engineering early on and decided to try it. They experimented with patients utilizing Minimed’s model and found it quite useful for hypoglycemic unawareness. However, many Type 2 diabetics may do quite well with this system.

DM) Are individuals encouraged and/or encouraged to try the latest cutting-edge treatments?

MM) In Kaiser, a CGM apparatus would be covered if the patient can’t achieve good glucose control even after exhausting all of the other attempts. This is, we have a step-wise (or evidence-based) way of employing new remedies. We’ve got quidelines for what therapies are appropriate to begin with, and what is the next step and the next step then.

We don’t look at these items insurance choices. These are medical decisions at KP.

It actually is an issue of the person and their doctor making the decision; should they think that current therapy is not working well, they could decide to proceed to the next step.

DM) How can your approach particularly progressive or distinct from what other healthcare organizations do?

MM) We actually have evidence that diabetes patients at KP do better than everywhere. For one thing, we have an innovative way of assessing actual costs. We’ve developed an analytical motor utilizing clinical and financial information to gauge the costs of covering certain inhabitants. By way of instance, we can take all the available information for folks who work in a rubber plant at Des Moines, Iowa, and estimate costs for this population.

With this predictive model we could compute outcomes 10 years from now when we alter the peoples’ therapy, i.e. when we implement a nutrition program or put them on certain medicines, what is the likely impact on their health issues? This is actually significant information, because we could save thousands of dollars and stop countless heart attacks!

In terms of diabetes care, we could understand that there’s generally a return on investment (ROI) of 2 or 3 dollars on each dollar set in. That is strong financial evidence that proactive diabetes therapy is a enormous cost savings for providers in the long term. For employers, in addition, it implies less absenteeism, no extra money wasted in simple treatments, and so forth.

DM) How does all this play from the individual’s perspective?

MM) We provide our expertise via web-based and telephone training, in which patients have direct contact with caregivers who help them develop plans for their individual needs. This isn’t only for chronic conditions, but also for nourishment, exercise, stress reduction, end-of-life care, plus even more. Here is the support which KP Healthy Solutions helps provide to organizations outside of Kaiser.

We’ve had the largest impact (cost savings and outcomes) with chronic conditions like asthma, diabetes, coronary heart disease, heart failure, and depression.

Depression is amazingly important. We’ve discovered that, by way of instance, a diabetic manhood generally spends 4x as many days at the hospital compared to an average member. With depression and diabetes, the member spends 8x as many days at the hospital. So among the first things we do is monitor patients for depression. In addition, we train our care teams on how best to determine motivational factors, and we’re making counseling part of the therapy program.

DM) What about early intervention and pre-diabetes care?

MM) We have guidelines for this, 220 pages of these! Seriously, if a man has a family history of diabetes or other markers, then we are doing Favorable screening. In addition, we understand you can’t use this sort of care for a cookie cutter approach; it needs to be tailored to the person.

Additionally, we have a fresh A-L-L initiative to incorporate cardiovascular hazard management to diabetes care. This states BG management is essential, but lipid management can also be crucial.   Cardiovasulcar complications associated with lipid abnormalities are among the greatest killers of diabetics. A combo of medications can really aid: Aspirin, Lovastatin, Lisinopril.

We’re targeting each diabetic over 55 and those with different complications, such as hypertension or coronary artery disease, and putting them on those three meds, that are shown to reduce cardiovascular disease by 20-30%. We see enormous impact already, because the complications of large BG show up much later, however, the cardiovascular disease (heart attack, stroke) generally show up within a few years.

Beyond this, we also possess an excellent proactive system of patient reminders for your next pap smear, next mammogram, etc.

DM) Kaiser got pretty beat up recently in the kidney transplant scandal. How is it working to restore patients’ religion in its care?

MM) I have to admit that we didn’t deal with this well. There is some irony in the sense that the true transplant care was good, but we snapped it with all the administrative section. We failed to get patients moved on the new waiting list in order of their current seniority. So individuals ended up in limbo on the receiver list.

What are we doing about it? Phasing out the transplant program. We brought the app in-house because we thought we could do much better job. But we’re admitting defeat within this field.

What we’re understanding is that individuals can’t deal with this sort of program without a significant administrative overhaul. So we’re shutting down that program till we’re sure can we get it done correctly. We’re not giving up on kidney care, but going back to utilizing outside contracted surgeons to run the transplant, at UC Davis and UCSF (that is how we did it previously).

DM) Finally, Kaiser’s unique capitation system (members pay a predetermined amount per covered “mind” per month) makes some people today think they’re barred from utilizing Kaiser unless their employer is contracted with the company. What’s the chance for individuals already diagnosed with diabetes to join Kaiser should they prefer?

MM) Many of the individuals who enter KP do come as a member of an employee group — especially if they have a pre-existing chronic condition, as as part of a team, they don’t need medical screening to join.

Should you apply as an individual, you do need to go through screening. And you may be denied or have limitations placed on your coverage, meaning you might need to pay for some remedies out of your pocket. And to be honest, some people likely do get rejected out of hand. That is a fantastic reason why the majority of folks look to work for a business offering fantastic medical insurance benefits.

DM) Dr. Mustille, what is your message into the diabetes community?

MM) I just feel that Kaiser is a very good location for those who have diabetes. A coordinated, organized system is the perfect method to look after a complex condition like this. So I’d say, if you’ve got access to Kaiser, then you should make the most of it.

You won’t hear that from many other health plans — asking possibly expensive members to join… but I’d say we do quite a good job with diabetes and people should make the most of it whenever they could!

Thanks, Dr. M, for giving us the provider perspective; we will all be curious to observe how Kaiser recovers by the latest scandals along with resignations. Ugh.

Disclaimer: Content Made by the Diabetes Mine team. For additional information click here.


This content is created for Diabetes Mine, a consumer health site centered on the diabetes community. The content isn’t medically reviewed and does not stick to Healthline’s editorial instructions. To learn more about Healthline’s partnership with Diabetes Mine, please click here.


Creating Policy for Continuous Glucose Monitors in Diabetes Care

No question that today in 2016, constant glucose monitors are pretty darn important to a lot of people living with diabetes.

CGM MattersPersonally my CGM has saved my life several times over the last few years by alerting me harmful sugar spikes when my mind couldn’t. Honestly, it provides me and others like me a level of protection that was not before accessible to people with diabetes during history.

Obviously, sporting a CGM is not for everybody. But those people that do turn to the technology, it really often becomes irreplaceable.

Surprisingly, we are still trying to convince doctors, insurance companies and policy makers about this crucial need.

Thankfully, the American Association of Clinical Endocrinologists (AACE), a professional company once quite removed from “from the trenches” patient requirements, is currently taking a stand to advocate for improved access to CGM and also for establishing this technology as a staple of diabetes control as opposed to an optional extra.

The nation’s top group of clinical endos is hosting a big meeting (officially dubbed a consensus conference) this weekend to discuss the key issues about patients’ use of CGM. The most important objective is to collect enough ammunition — in terms of both clinical data and patient input to convince payors and policymakers that supporting CGM is imperative.

The meeting taking place on Saturday, Feb. 20, at Washington D.C. actually stems from a September 2014 AACE conference on sugar tracking, when experts decided that beyond talking accuracy of fingerstick meters, there was a demand for another gathering to hone in about CGM. It is going to probably follow exactly the same route leading up to a policy statement.

The forum unfortunately won’t be live-streamed or shared on social websites like so many events are nowadays, so we’ll have to go the old fashioned route and wait for a report to be composed and dispersed after the fact.

We at DiabetesMine were among a bunch of advocates, policy and organizational leaders requested to help hammer out this assembly will unfold by simply answering a string of queries. The group offered a pretty wide spectrum of private and professional insight about CGM use.

Why Do We Want a ‘CGM Policy’?

We have written about the issue of advancing access to CGM earlier — particularly as it relates to people on Medicare — and it’s no secret that we believe CGMs should be considered core therapy. That’s why this AACE assembly and subsequent policy statement matter.

This consensus statement is predicted to be extensive and tackle several of topics that matter to people PWDs: just how CGM should be used, the advantages and disadvantages, and implications for its general effect on cardiovascular disease care. Much more to the point, the statement will probably guide how CGM coverage is created by both Medicare and private insurance: particulars of the way the devices are covered, the way doctors will be reimbursed for analyzing data, and whether professional “blind CGM” tech fits into the equation, for instance.

I can just feel my own Dexcom G4 vibrating with excitement of all of the CGM chat… Oh wait, that was my tight alert. Sorry, allow me to take care of that. 😉

During the info-gathering procedure, we were particularly impressed with how curious AACE appears to be in shaping better coverage how this technology is utilized, by physicians and through doctors’ and teachers — that are of course the ones writing the prescriptions. They’re really standing behind the need to expand patient usage, finally recognizing how life-impacting CGMs can be.

The (quite text-heavy) slip below shared with AACE sums up this nicely, showing data on how many lives could be saved and improved by CGM, particularly among elderly populations and those people who may end up in the clinic without it.

AACE Calls for Patient Input CGM Use

Here are some of the questions we were asked to chime in on, and our responses based on our experience as patients and neighborhood advocates:

AACE) How can patients, physicians and payers benefit from expanded use of private and professional CGM?

DM) Improved safety and lower prices. The incidence of hypoglycemia and hyperglycemia will be reduced as a consequence of better management thanks to widespread usage of CGM. Danger of high and very low blood sugars could be caught and addressed sooner, meaning fewer insulin reactions and DKA cases would arise. This would result in a decline in hospital visits and emergency treatments from the short-term, and at the long-term it would diminish the expense of hospital care and mortalities that stem out of unchecked glucose variability and the subsequent complications.

Professional CGM use sounds less mandatory nowadays, but it could be of use for people unsure of private CGM (including in the T2 inhabitants) and individuals who cannot afford to purchase the needed equipment and supplies.

What data support the use of CGM for either personal or professional use?

Multiple studies — including most recent research by Dr. Irl Hirsch, in addition to the CMS studies relating to CGM use in elderly populations. Several other clinical studies are weaving CGM usage in their protocols onto a less official basis, including studies for the newest intranasal glucagon where several patients used CGM as an instrument to track the effectiveness of the publication glucagon formulation.

What patient populations are best served by this technology dependent on the research?

All sufferers. Needless to say, those most at risk for all these high and very low blood glucose situations would be the population and elderly, but that doesn’t diminish the importance to teenagers and adults who might be out of scope or in need of greater tracking by CGM. Naturally, patients who undergo hypoglycemia unawareness stand to gain from this; this dangerous condition is highly common among patients living with type 1 diabetes for a long time or more.

What will be the implications on the medical system of not fixing glycemic variability which results in short-term acute hypos/hospitalizations, and long-term complications/hyperglycemia?

The easy fact that this question has been requested in 2016 is proof of how outdated our healthcare system actually is. The reply to this question should be clear to anyone who’s been practicing in diabetes care because 2006.

As physicians move toward outcome-based treatment, they ought to be keenly aware of the bad consequences of patients who don’t closely monitor their sugar values. CGM is an invaluable tool offering a broad picture of the way patients are faring with their diabetes way beyond the very simple A1C, an average value that may often represent nothing but the mid-point between too-high along with too-low glucose levels. The implications of not utilizing CGM should be quite clear: bad patient outcomes, and higher prices in both the short and long-term.

Is it required to review data in different groups to determine the effect on improved control of diabetes, and not necessarily just a decrease A1C, but a better quality of life?

Yes! ‘Your Diabetes May Vary’ is now a key mantra at the Diabetes Community, since no two patients will be exactly the same. We are not textbook patients, and it calms our confidence from our physicians if we are treated as such. With today’s capabilities to collect and analyze Big Data, it behooves us to examine youth inhabitants, young adults, seniors, etc., because “inhabitants” that may share important features.

Additionally, as noted previously, an A1C is a simple average that may be deceiving. A more meaningful measure is “period in scope” together with sugar. And remember that QUALITY OF LIFE trumps all no patient will ever be “compliant” or thrive using their diabetes care if they’re suffering from depression, anxiety or other mental or physical conditions that negatively affect their lifestyles.

What CGM data are applicable and should it be mentioned?

Allow patients have access to their own data, so that they could decide what is important and what they need the maximum at a particular time. If they require assistance, this should be for the health care provider to offer. But it should not be a patriarchal system, where the HCP (or industry vendor) has initial state and control over just what the patient sees concerning diabetes data. Let us empower ourselves, because it will save us all time and cash in the long run. HCPs can and should be present to assist as required.

What information from CGM engineering is essential for patients and physicians to manage diabetes and improve outcomes?

All of it. Trends, patterns, Highs and Lows… Perhaps not the spaghetti charts that too often leave patients perplexed and not able to discern what actions they have to take. The raw data should all be accessible, but we also need great tools to allow us to extract meaning from the data.

What key metrics should be considered: time-in-range, percent time above/below scope, etc.)?

Time in scope is very important. This helps us determine exactly how “well” we’re doing, and identify these times not in scope so we are able to work with our HCP to maximize our management.

Could standardized data coverage support patient control, physician use, and training of physicians and patients?

Absolutely. Having criteria in place that support a universal data language and coverage system will surely help patients, HCPs, and additionally the sector to realize accurate diabetes data and apparatus INTEROPERABILITY.

In the summary of all answers shared by AACE, the slip pictured below reveals said Pros and Cons of standardized coverage:

What data are essential? How should it be standardized, i.e., should data be broken into different times like fasting, post-prandial, bedtime, hypoglycemic episodes along with their own times?

All of those data points should be clearly available to the patient and physician. There’s not any REASON to exclude any of these data points.

Who should interpret that data to utilize it in a very efficient way, and is coaching required needed?

Providers should have some training, yes. Tools such as Tidepool, Glooko and Diasend will make data rendering easy for everybody.

What is the effect of blood sugar monitoring and what would be the effect of CGM on patients’ frequency of blood sugar monitoring?

Dexcom has said that their goal is to replace fingersticks, also we aren’t far away from if CGM data will be accurate enough to earn insulin dosing choices. We are moving towards an age where CGM is going to be regular glucose measurement.

Per the AACE overview, not all concur that regular glucose measurement could be left handed, as shown in this slide:

What results measures (behavioral, clinical, lab, etc.) can be used by providers and payers to assess meaningful usage of CGM in their own patients and warrant decisions on continuing need/coverage?

Greater time in scope, and patient satisfaction studies in which people report changes in wellbeing.

What Now?

We hugely enjoy AACE calling for patient feedback from crafting this seminar, and we look forward to watching what materializes!

While we all wait for a record and ultimate consensus statement by AACE, we are hoping the D-Community could voice their views about this. We expect that AACE will be using its own presence on Twitter (@TheAACE) to share live nuggets by the conference, too.

What do you all believe, D-Friends?

Disclaimer: Content created by this Diabetes Mine team. For more details click here.


This content is made for Diabetes Mine, a user health site centered on the diabetes area. The content is not medically reviewed and does not stick to Healthline’s editorial recommendations. For more information regarding Healthline’s venture with Diabetes Mine, please see here.


Cheap Carpet Cleaners Nottingham

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Consider Your Needs

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Choose A Company With The Skills You Need

Once you know the cleaning work you need to be carried out, it will be much easier to find a company that can best fill your needs. If you can find a company that specializes in the type of carpets and furniture you need cleaning you could be on to a great thing.

Don’t be afraid to ask the company you have in mind about that type of experience they have. A reputable company should be more than willing to share their experience with you and openly tell you if they have not cleaned a particular item which is on your list.

Best tip from Clean Notts that carpets and furniture have to deal with a lot of traffic and use. In fact, it can be rather startling to learn about just how much dirt and grime are lurking in the fibers or our carpets and furniture. A professional carpet and upholstery company will be able to transform your tired carpets and worn pieces of furniture into something much more appealing, as well as hygienic! So if you are looking for a great carpet and upholstery cleaning company in Nottingham, don’t be overwhelmed by how many choices are available. By following the tips we have outlined above we hope that you will be well on the way to a great decision!