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]

Roger that Ms Berta I whole heatedly agree .

but some times when we just copt the header link  the veterans don't seem to read it   b/c its to much reading,.

I just want to get what information I can and find  it and copy the main parts that answer their question or questions...I have did this  for years and no one ever sued me or gripe me out about it yet?

  The main thing is to get the information to the Veterans  and to me no matter how I do it  I just do it, if it helps a veteran out then I'll do it  besides if its  for public view  why not.

I always forget to put what sourch : and I guess I need to start added that  but so much reading and research I try to do and my mind is on getting the information to the Veteran.

Sorry that this bothers you.

Edited May 14, 2017 by Buck52

[OldSkool33]

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?

 

[pwrslm]

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.

Edited May 13, 2017 by pwrslm

[Buck52]

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  

Edited May 13, 2017 by Buck52

[Berta]

" I was told that we can not sue the VA and that the doctors and nurse, however, can be sued."

That is not true . 

"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. " 

Not true either. I dont know who is telling you this erroneous stuff. I settled with VA for wrongful death. My settlement was with the USA, under the signature of VA OGC.

An internal document I have from OGC says their VACO  doctor states the death of my husband due to "multiple deviations" from normal care as found in the non VA medical community, could Not be defended in a court of law. Meaning if I didn't like the settlement (which I negotiated myself and acceopted) and if I then  formally Sued in Federal court ,I would be suing the VA and all of the medical records would be certainly used in court. 

Veterans and their survivors have gotten Millions in the federal Court due to piss poor VA health care----some awards  are linked in our 1151/ FTCA forum here.

This is not a FTCA or Section 1151 matter however.....please disregard all of my past advice here. I just wanted to straighten out that misinfoformation you got.

If we can read the most recent denial we can help more.

Just cover C file # name, and scan and attach their Reason and Bases for the denial and the evidence list.

VA must apply Fast Letter 10-35 to these types of claims.

 

 

Edited May 13, 2017 by Berta

[OldSkool33]

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 ;-)