Medical Documentation Problems
Medical professionals and healthcare providers who submit claims to Medicare and Medicaid are required to maintain proper documentation. Failure to maintain proper documentation can result in liability for making "false claims," even if you actually provided the treatment.
When an audit or investigation reveals missing or incomplete medical documentation, the government will take the position that any claims for reimbursement from Medicare, Medicaid, or another government healthcare program were false claims. This can result in demands for refunds, treble damages, penalties, and possibly allegations of fraud.
Evidence that medical records have been altered or falsified could result in your case being referred to the FBI or a U.S. Attorney for a criminal investigation and prosecution.
Examples of Incomplete and False Medical Records
Inadequate Dental Records
A dentist entered into a consent order agreeing to pay $30,000 to Medicaid after investigators discovered billing irregularities and documentation problems. According to the consent order, Peter J. D'Allessandro "failed to maintain adequate records to support and justify treatments." Click here to read more....
Inadequate In-Patient Hospital Records
Wyoming Medical Center agreed to pay $2.7 million to settle claims that it committed fraud against Medicare by submitting inpatient reimbursement claims for hospital stays where there was no record of a physician ordering inpatient-level care. Click here to read more....
Inadequate Mental Health Records
Westchester Medical Center (“WMC”) agreed to pay $7 million to settle a False Claims Act lawsuit alleging that it billed Medicaid for millions of dollars of outpatient services at its mental health center that lacked the core documentation required by Medicaid regulations. Those regulations require that mental health outpatient clinics maintain certain documents, including progress notes and treatment plans, to ensure that billed services are actually provided, and that the providers are in compliance with the regulations. Click here to read more....
John Howley, Esq.
350 Fifth Avenue, 59th Floor
New York, New York 10118