What's Best Recourse To Address Falsified Medical Records?

[OldSkool33]

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?

Edited May 13, 2017 by OldSkool33

[Buck52]

you might check with OIG Office.

Here is what I found from

Collins & Collins Attorney Law Firm :Source

''Make no mistake these claims will be hard.  If files have been falsified, it is not enough to get the medical records and have them reviewed by a lawyer and then a medical expert.  It will also be necessary to get a forensic expert to determine if falsifications have taken place.''

''This puts veterans and their families at a huge disadvantage.  Indictments are not enough. The records need to be corrected and all veterans ever remotely possibly affected should be notified immediately.  Perhaps it is skeptical, but this seems highly unlikely in light of the many ongoing and seemingly never ending stream of injustices committed against veterans by their own healthcare system.''

if those false records had your name on it and claim #  your probably right to go after them  but if it was another veterans   then that could be a problem.

Edited May 13, 2017 by Buck52

[Berta]

BUCK....I just made a comment about Plagarism....in the DIC thread I just replied to....

Some of this comes directly from this link:

http://www.collinsattorneys.com/injuryblawg/medical-malpractice/falsification-of-va-medical-records-and-statutes-of-limitations-for-medical-malpractice-claims/

It is not enough to change the look of a entry from another site, it must be in Quotes and given the source.

 

I suggest you change your post ASAP because the site is a lawyers site. It might even have a copyright requirement.

They may have a contact area as well where the veteran here can direct their question on that to them.

Geez................................... 

 

 

Edited May 13, 2017 by Berta

[Berta]

The point I made on plagarism is in this thread ,the last point:

 

[OldSkool33]

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?

Edited May 13, 2017 by OldSkool33

[Berta]

I suggest that the veteran email the Secretary at  david.j.shulkin@va.gov, and also contact the IG- their link is here and at google-

and he should file an IRIS complaint. (IRIS is reached via www.va.gov under the Contact Us Section.)

The only reason I suggest that the veteran do this is because IRIS , the Secretary and the OIG will want his C file # etc...

However, was this a case that the veteran did not show up for a scheduled C & P exam due to death in family Or

have you or the veteran checked to see the C file # and name of the vet on the exam to see if it was actually his exam or someone else's ?

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

Yeah, something stinks here.Big time.

Was this exam a farmed out exam or done at a VAMC? If it was farmed  out how did the vet get a copy of it----if no decision has been made yet on the claim?

I have dealt with bogus C & P exams for over 20 years, because the fact that the veteran ,my husband, was dead and could not speak for himself , gave the VA leeway to write up lots of crap,in 'posthumous 'C & P exams, but it did them no good whatsoever..

C & P examiners have been the subject of many problems with the VA, and some vets took them to task on it.

Good for you! You are willing to take a stand but then again this is really up to the veteran himself to take action because of 5 USC 552-the Privacy Act. Still I would get this documented with the Secretary if you have the veteran's written permission and C file #.

 

 

[Berta]

Here is the VA OIG link:

https://www.va.gov/oig/

You can use the Hot line area.

I have contacted them before myself so 

Tell them right away that this is not a claims question,  and you are contacting (or have contacted) Secretary Shulkin's office about it. Tell them it's impact on a pending claim however is serious and this should not happen to any VA claimant. Give them the date and name of the examiner and where the exam was done and the RO involved.