On July 8, 2013 the United States Attorney’s Office for the Southern District of Florida issued a Press Release with the headline “Supervisor of $63 Million Health Care Fraud Scheme Sentenced in Florida To 10 Years in Prison”. The Defendant, a 51 year old employee of the Healthcare Provider was the director of medical records. The employee was a certified medical records technician and was found to have overseen the alteration, fabrication and forgery of documents that were used to support claims submitted to Medicare and Medicaid. In addition, the employee was found to have directed therapists to fabricate documents and forged signatures on documents. The defective medical records were used to support claims to Medicare and Medicaid in excess of 63 million dollars.
Defective medical records can cause enormous problems as Professionals might not prescribe a course of treatment because the record indicates it was already provided or possibly prescribe unneeded treatment pursuant to the record. Either way the result is bad.
Healthcare Professionals need to be vigilant in maintaining accurate and complete medical records to avoid violating the law and can reduce the risk related to inaccurate medical records by creating and maintaining a Compliance plan that provides protocols and standards for creation, maintenance and auditing of medical records.