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

[broncovet]

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.  

[OldSkool33]

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.

[Buck52]

 Please take Note:

oldschool  my apology to you sir I forgot to Put the Sourch: > from where I get my information.

  It was not me that originally wrote this information  but  from Law Firms and Attorneys.

and other internet web sites.

Usually I just read the information an copy it and put it on here for any veteran to read and hopefully help.

As I sometimes do not  just copy the whole link  because of much much reading involved.

Here is a link I copy from  the 2000 Introduction of the VACC changes  it may help you to read and understand them.

https://www.bva.va.gov/docs/VLR_VOL3/6-GriffinAndJones-VCAA-TenYearsLaterPages284-321.pdf

Again I apology to you if I have misled you in anyway or gave you some wrong information or not add the link or not giving you my sourch:

Or want you to think this is my whole Ideal (Information I put up)

All of my information I will try my best to not forget to put the link on here or my sourch:  

Please Note: 

my opinions are just that  ''my opinion''  & is from my experiences and not intended for  legal Help  & I am not a VA Attorney or any other type of Attorney. or certified Veteran Rep or VSO.

 I am simply a S.C. Disabled Vietnam Combat Veteran with some past claims experience that loves to help other veterans win their claims and as fast as possible.

I do not accept any $$ or any favors from veterans I help , all my time is volunteer and is free of charge.

Thanks

 

Edited May 17, 2017 by Buck52