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Saturday, June 13, 2009

Falsifying Medical Records

I find this to be an interesting story which takes me back to a situation in which I had an ethical and professional obligation to become a whistle blower.

It wasn't the first experience I'd had as a whistle blower. The good part is that I had the opportunity to work with Region X HHS Office of the Inspector General once again and also a good federal prosecutor.

Their comments following the $372 million win in the case against the company for insurance fraud was another KUDO for the veracity of my information.

The sad part, being that this event occurred in Washington state, is that not only did the Medicaid Fraud office not act, but it allowed a nurse (not a medical billing person) to get away with a concerted effort to falsify patient records at this health facility for minor children, through false complaints against me.

There was quite a long list list of irregularities at this facility in addition to falsifying records in the week before state inspectors were to arrive to certify the treatment center for state Medicaid payments.

One of the insurance fraud issues I tried to report to the state were several admissions that did not meet diagnostic criteria. The admission allowed the center to bill at about $10 thousand a pop.

The state to this day has failed to investigate my claim. Nurses employed at the state QA office were involved in withholding evidence that proved their action was false. If they admitted their actions they would have had to take action against the nurse in my complaint, another WSNA insider. Just shows the politics of it all.

By the way, the QA nurse got a promotion to health policy in the Secretary's office and the other, now an "advanced practice" nurse (who sexually harassed minor female patients and me), is still at work in a Whatcom county, Washington community.

Facts don't matter, even when children's lives and health are involved. Health care is still an industry and it is ALL ABOUT THE DO-RE-MI.

The list of violations in this one case are extensive. The most egregious involved a 15 year old sex offender we admitted, and against my concerns, placed him with a 12 year old in the room farthest from the office. This was not an approved dual diagnosis program just to add another aspect of the story.

But one good thing happened. Even though Medicaid Fraud and the AG would not act to investigate, the state's AAG came to my defense as did state and federal legislators. Plus I won a judgment against the state.

Of course I'm still waiting to learn how this order was honored. The Adjudicative Clerk's office can't seem to find it even though I have receipt of service.

Now that the Gregoire's are gone, Rob McKenna has the obligation to act.
Posted on Thu, Jun. 11, 2009, Police: Mom forged school excuses
Woman jailed for what officials say are faked doctor's notes
By Mike Cherney,

An Horry County woman has been charged with forgery after police said she wrote fake doctor's notices to excuse four students, including her own child, from classes at Socastee High School.

Naomi Antoinette Aranda, 45, was arrested and booked into J. Reuben Long Detention Center on Wednesday morning and was released on a personal recognizance bond later in the afternoon.

Aranda could not be reached for comment Wednesday.

She has been charged with four counts of forgery with no dollar amount involved.

The offense is a misdemeanor, and she faces a maximum penalty of three years in jail for each charge and a fine to be determined by the court, according to the state code.

Police and school officials said it is rare for someone to be jailed for forging doctor's notes, though they hoped the case would help to educate the public about the seriousness of school attendance.

"We put it out there in an attempt to prevent future incidents like this occurring," said Sgt. Robert Kegler of the Horry County Police Department.

"Let people be aware this is a jailable offense."

Police are accusing Aranda of using business cards and forms to forge letterheads and faxing them to the school.

The investigation began last month, police said.

Teal Britton, a spokeswoman for Horry County Schools, said students are required to have a doctor's note if they are unable to attend school because of an illness.

Absences without a note, proof of a death in the family or the principal's permission are considered unlawful, she said.

In this particular case, Britton said school officials notified physicians that someone appeared to be forging their notes.

Britton said school officials can often tell if a note appears forged because many doctors use specific ink or color of paper for their notices.

"Our primary focus is how do we get parents and students to understand the significance of being in school when they are able to be in school," she said. "It's not a situation where you wish harm or embarrassment on anyone, but [we're] hopeful just the awareness ... would discourage anyone from thinking of doing that for themselves or for their child."

Contact MIKE CHERNEY at 444-1765.
© 2009 and wire service sources. All Rights Reserved.

1 comment:

electronic medical records said...

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