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

[OldSkool33]

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!

Edited May 14, 2017 by OldSkool33

[OldSkool33]

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!

[Buck52]

got this off hadit!

[Buck52]

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

How Do you Prevent Development to Deny?  

''You can’t really prevent it – but you can fight it and you can protect against a Court endorsing this tactic.''

Load your C-File with as much Competent and Credible Lay Evidence as you can find,  then go out and get solid Medical Evidence to analyze the C-File, include the Magic Words in your private medical opinion.''

''Go take a look at  Hart v. Mansfield, 21 Vet.App. 505, 508 (2007).''

''It will help you understand why the VA may not pursue development of the record if the purpose is to obtain evidence against the claim.''

: Source

''Chris Attig''  Attorney

''V.L.B.''

Chris Attig is without doubt one of the best Veterans Attorney's in the business, if your having problems with your VA Claim  give Chris Office a Call.

Edited May 14, 2017 by Buck52

[broncovet]

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

One important case is CUSHMAN:

In part:

Quote

 

In April of 1980, the Board affirmed the decision of the Regional Office. Although the Board did not cite any particular evidence on which it relied in making its decision, the Board concluded that “the evidence fails to show the presence of symptomology which would preclude sedentary employment.” The medical record before the Regional Office and Board, however, differed from the medical record on file at the DVA Outpatient Clinic. Namely, one of the doctor’s entries had been altered to change the language “Is worse + must stop present type of work” to instead read, “Is worse + must stop present type of work, or at least [] bend [] stoop lift.” (emphasis added, brackets indicate illegible or stray marks). The altered record also contained the additional entry, “says he is applying for reevaluation of back condition,” which does not appear in the official record on file with the Outpatient Clinic. The alterations appeared in the last, i.e., most recent, doctor’s notes documenting Mr. Cushman’s condition. Mr. Cushman sought reconsideration of the Board’s 1980 decision. In 1982, the Board affirmed its prior decision based on the same evidentiary record. During this time, Mr. Cushman also filed a claim for disability benefits from the Social Security Administration (“SSA”). The SSA requested Mr. Cushman’s medical records from the DVA to consider in determining Mr. Cushman’s eligibility for SSA disability benefits. The DVA sent to the SSA the version of Mr. Cushman’s medical record that was on file with the Regional Office, i.e., the altered version. The SSA denied Mr. Cushman’s claim, repeating in its decision language that appears only in the altered version of Mr. Cushman’s record.

 

Source: 

United States Court of Appeals for the Federal Circuit 2008-7129 PHILIP E. CUSHMAN, Claimant-Appellant, v. ERIC K. SHINSEKI, Secretary of Veterans Affairs, Respondent-Appellee   available here:

http://www.cafc.uscourts.gov/sites/default/files/opinions-orders/08-7129.pdf

[broncovet]

In Cushman, VA got away with it, no VA employees were ever prosecuted for falsification of records.  There is no accountability.