The link between corrupt medical records and fraud made headlines in three states last week in cases ranging from botched electronic health record entries to forged prescriptions.
A pulmonologist in an Alabama veterans' hospital, for instance, copied old information into patients' electronic health records more than 1,200 times in two years, USA Today reported. The doctor blamed his "technical incompetence" and "stupidity" for the information mingling; but "if third-party payers were billed for any of the pulmonologist's medical evaluations based on copied and pasted entries into the medical record, this could constitute fraud," according to a report by the VA's Office of the Medical Inspector.
And Tina Kuehl, owner of a home healthcare company in Missouri, was sent to prison after telling nurses and other staff to inflate numbers of therapy sessions patients received to generate higher insurance payments, the St. Louis Post-Dispatch reported. She also directed employees to enter false diagnoses and exaggerate the extent of patients' illnesses, prosecutors said. When some staff refused to do this, Kuehl fudged the medical records herself. Kuehl's company filed hundreds of Medicare claims for services never performed, the article added.
This case recalls Assistant U.S. Attorney Ted Radway's description of "charting parties," where unscrupulous providers gather people in a room to alter, destroy or fabricate medical records. Typically this happens in response to a subpoena or payer audit, Radway previously told FierceHealthPayer:Anti-Fraud.
In another case of telling staff to lie, Philadelphia chiropractor Lawrence Herman was sent to prison after fabricating evidence of treatment for injuries sustained in a car accident, according to Alert CC. The accident was a fender bender, and Herman wasn't seriously hurt. But he asked a staffer to create false evidence of treatments for neck and back treatments and send this to his insurer on fake letterhead. Meanwhile, Herman ran marathons, Alert CC noted.
Finally, medical assistant Sandra Jalowiec was charged with fraud for billing Blue Cross of Northeastern Pennsylvania for painkiller prescriptions she forged, the Times Leader reported. Jalowiec ran the scheme for more than six years, prosecutors allege.