[What's Best Recourse To Address Falsified Medical Records?]

On 5/14/2017 at 5:58 PM, broncovet said:

IMHO, it isnt "developing to deny" to ask for another opinion to resolve conflicting opinions.  While, as you stated, there apparently were both favorable and unfavorable opinions, the VA CAN choose one opinion over another but must give a reasons and bases as to why one opinion was chosen over another.  Some examples are:  One opinion is more thorough, such as your regular doc who had seen you for years, vs a one time c and p doc.  Another possibility is that VA can decide that one opinion is more credible than the others, such as one being offered by a specialist in that field vs a family practice doc.  

Developing to deny is if you have favorable evidence and they seek unfavorable.  The BOD may or may not have applied for reasons given above, plus more such as one doc read your cfile and another did not so state.  

 

Good advice. Sometimes there are a lot of unseen threads in the working of a claim. Its not always as simple as it seems.

Generally speaking though, if all things are equal and they have enough info to make a decision, they're supposed to rule in favor of the vet, not seek yet another opinion. It would be nice if it stayed just that simple. Life's too short to play shell games for benefits.

[What's Best Recourse To Address Falsified Medical Records?]

11 minutes ago, Berta said:

"So my question is, would the veteran be able to request a stay against the reduction based on VCAA in order to get the documents needed to properly evaluate the intent to reduce? "

Maybe if they violated the VCAA The entire Act is here somewhere but still this claim will need in my opinion an IMO/IME  for a proper resolve and that would be mandatory anyhow  for a Sec 1151 claim or FTCA claim or both.

 

The injury only aggravated an already rated condition. We did get the ER report from Release of Information. And they erroneously labeled the cause of the injury as 'exercise' ... it was the VA ER, IDK why I expected anything different when filing a complaint on VA C&P, but I digress. I think you're right about the IMO/IME. Its a little difficult finding someone to do that. Primarily the concern right now is, I can't give the Doc the records to review in order to reach an opinion. I need the VAs assistance in the form of 'give me my records, please'.

12 minutes ago, Berta said:

We had a vet here, I think for a foot condition and he got a C & P from a gynecologist.

That's too funny. Actually, the Doc who signed off on the original C&P exam in the OP was an Ob/Gyn opining on ortho conditions.

13 minutes ago, Berta said:

The VA is SNAFUed and FUBARed up the ying yangs. 

This is unfortunately true.

[What's Best Recourse To Address Falsified Medical Records?]

1 hour ago, Berta said:

I asked for a remand because the VA did not give me my VCAA rights

I'm not very well educated on the finer points of the VCAA. I get the jest of it. But maybe I can find an immediate application for it?

I'm trying to be as generic as possible because it isn't my claim. So I have to ask in general terms. I have a letter of intent to reduce disability ratings. The letter itself contains some medical blah blah blah about why they reached their conclusion. They also listed every document and source of information they claim to have used in making their decision.

The C-File has been like pulling teeth to get, but a disk with some of it arrived about a week ago. It is incomplete and contains none of the documents that were declared  Any of the potential information found with the "Blue Button" is reported with a message similar to, "You may not view this record".

The intent to reduce gives us a 60-day window before they take action. But without the records in question, how can I give a knowledgeable response?

The difficulty is compounded because among the documents listed is another problematic C&P exam. The exam in question was incomplete because the Examiner actually caused injury to the Veteran who immediately left the C&P office to go to the ER.

WTH is in that report? And they based an intent to reduce benefits on that? So my question is, would the veteran be able to request a stay against the reduction based on VCAA in order to get the documents needed to properly evaluate the intent to reduce? We all know those records will take more than 60 days to get if they ever show up.

I know this gets tricky because it ventures into the fuzziness of the NOD and appeals requests and so on. But I'm just wondering if there's something in the VCAA that might leverage a stay on the reduction.

[Any Referral For Ortho or GP IMO/IME in North Florida/South Georgia]

Any Referral For Ortho or GP IMO/IME in North Florida/South Georgia? 

[What's Best Recourse To Address Falsified Medical Records?]

4 hours ago, broncovet said:

 

This is an ongoing problem, and your's is not the first records falsified by VA in order to deny.  

 

 

I'm becoming painfully aware of this fact. The more I look into our own files, I'm realizing this isn't the first or last time they've done it to me. Add that to the probability that every one of us may have the same problem and OMG, its mindblowing. 

In terms of getting away with it, I don't know exactly how to respond. Is it possible that Mr. Cushman's primary interest was in his claim? I'm sure the case was stressful enough. You would think that the regulatory authorities would grab something like this without the need for prompting. Maybe you have to actually file those charges with the appropriate agency to follow through with it.

[What's Best Recourse To Address Falsified Medical Records?]

6 hours ago, Buck52 said:

The VA goes out to get evidence to help deny the claim when everything in the record says that the claim should be granted.

 

This is system wide, isn't it? Thanks for the references, will look into it. Hopefully, future legislation and policy changes will address these issues. I hate the thought that many of our brothers and sisters in crisis were driven there by the system they had turned to for help.

[What's Best Recourse To Address Falsified Medical Records?]

12 hours ago, Berta said:

I dont know who is telling you this erroneous stuff.

Got these and other gems from VSOs. I didn't say I believed them. That's just an example of the quality of advice we've gotten inside the system. When the foxes guard the henhouse, somebody's having chicken for lunch.

I don't mean to confuse the issues. Resolving the actual claim, pursuing an 1151/ FTCA claim and pursuing felony allegations of falsification are each individual concerns. Keeping them organized in our thinking is tricky.

The Fast Letter 10-35 is good advice. That's going to help, I'm sure. Eventually, I expect we may chase the 1151/FTCA claim. 

It grieves me that so many have had the experiences they've had with the VA. But I'm glad you guys are willing to share from those experiences to help others. That's awesome!

[What's Best Recourse To Address Falsified Medical Records?]

13 hours ago, Buck52 said:

I would have your wife to go seek an IMO from a specialist  ENT  using the VA Criteria  for hearing loss and ask the specialist TO RENDER AN OPINION  and take medical records from military Pertaint to her claim   VA &  Ask  Nicely  if she would state that her hearing impairment is likely as not caused by her military service from being around excessive loud noise while in the military

bilateral hearing loss accrues with loud noise exposure  and  also her MOS.

If there's two Dr's in conflict about there medical opinion the VA will usually take the Specialist Word....this is normally called Equipoise  

 

 

 

I know I chased this a little off topic. And I appreciate the advice, it might be the most effective way to resolve that aspect of the claim. The problem is, that we have one expert opinion that is not favorable, then a second expert opinion that is favorable. That should be sufficient already, right? Well, apparently not, they enlisted a THIRD opinion that came back unfavorably. That "added weight" tips the scales against us. The problem is, that third opinion is Development to Deny ... right? Why can't I just point to that and tell them where to put it?

Thumbs up "S. 1094". that's good news!

[What's Best Recourse To Address Falsified Medical Records?]

13 hours ago, pwrslm said:

http://www.disabledveterans.org/2015/07/21/veterans-health-records-falsification-is-illegal/

 

Falsification of Medical Records is a felony.  You might also want to report in to your states attorney general as well.  Throw as much against the wall as you can, and hope something sticks. The VAOIG is responsible for enforcing violation of federal laws by VA employees, but they dont enforce state laws, and if the State Atty Genl's office is poking their nose into the issue, its much harder to hide the truth.

 

Exactly. Its not as much about vindication for us as it is about making things right. If a healthcare provider will do it to me, they will do it to you, too. Licensure is separate from the Feds, its a state function and they oversee healthcare practices. And yeah, the more mud you throw on the wall, the more may actually stick ;-)

[What's Best Recourse To Address Falsified Medical Records?]

The "veteran" is my wife. And she has been a nurse for a very long time and knows what is allowed or not allowed in medical documentation. They stepped all over it and big time. I was told that we can not sue the VA and that the doctors and nurse, however, can be sued. Then I was told that the VA health care records are the property of the VA and can not be allowed in a court of law. With all that being said, what recourse do we actually have as it is very obvious that harm has been done?  Also, "Development to Deny" actually happened last year during another C&P exam. First, my wife was diagnosed and given hearing aids to wear by the VA. Second, she applies for service connection for this. Third, a C&P doctor "reviewed her medical file and her military records ( of which I might add we still don't have a copy of or a complete C file with the Va so-called "evidence" that they state when denying claims because the evidence they cite is not new and material...how is she gonna know what IS new and material if she doesn't have a complete C file? Well, the "development of Denial" was after she filed for SC for the hearing loss, a C&P exam was done without her present they just reviewed her records....and so no it's not service connected...but the VA made another mistake because they "accidentally" sent her to another QTC "contractor" outside of the VA for a hearing exam. This audiologist said it was service connected but now there were conflicting exams...so what does the VA do? You guessed it they got a THIRD opinion and said it was not service connected. The did a "development to deny" I thought that was illegal as well? or is that only if the veteran was to do it?

 

[What's Best Recourse To Address Falsified Medical Records?]

Thanks, Buck. The OIG was on my list of potential steps to take. I wasn't sure if anyone else had ventured into this specific area and had any good advice from their own experience. One of the bigger problems with these things is that it violates your trust and then you're not sure who you can go to for help.

But in this case, documenting the fraud shouldn't be too hard. At the time of the fake C&P exam, the veteran in question (we're family) was 800 miles away from the C&P office burying Dad. That stirs up a lot of emotion, but it turns out to be fortuitous in terms of documenting the fraud. Its hard to be in two places at once and there's plenty of support for that "alibi".

One of the things that does bother me about it is the inevitable crap-storm the family will have to go through. But maybe if we take the right steps, we can limit that. For example, what if we approach the State Licensure authorities first and let them deal directly with the "healthcare professional"? I'm sure that's going to make somebody mad, but maybe it will force accountability and keep the thing from mysteriously disappearing under the rug?

Also thinking about how to address this in the actual case. Maybe its Development to Deny?

[What's Best Recourse To Address Falsified Medical Records?]

Hey, y'all I'm the new kid. Yes I tried searching. I had trouble finding my answers. Now I'm drowning in data and could use some help. If the topic already exists, a point in the right direction would be awesome.

So here's the situation. In the middle of processing a claim, the C-file finally arrives and there's an entire C&P exam in there that NEVER happened. And it is not just the fictitious exam, but a whole chain of communication and DBQs pursuant to it. Its insane!

In terms of processing the actual claim, I think I'm OK. But in terms of the falsification of records, I'm not OK. The question I have is, what next? I can deal with the claim separately. I want to see punitive action like going for medical licenses and facility accountability. I'd also like to know if there's recourse for malpractice since the illegal activity has done financial harm.

They would crucify us for fraud, can't I at least poke them in the eye or something?