Fraudulent Documentation

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LNCtips.com: Fraudulent Documentation


Picture this: You work for a defense attorney who, on the eve of trial, finds out that his or her client fraudulently altered the plaintiff's medical records. How does this situation happen and what's the role of legal nurse consultants who work with plaintiff and defense attorneys?

How does this happen? It happens before the lawsuit is even started. A patient obtains a copy of his or her medical records from a potential defendant, a healthcare provider. The patient gives these records to a plaintiff law firm to review. Patient requests for records occur all the time so the healthcare provider isn't concerned about this particular request.

Then, a few weeks or months later, the law firm sends a letter to the healthcare provider with an authorization from the same patient who obtained the records previously. Because the authorization request comes from an attorney's office, the patient's records suddenly become an object of great scrutiny.

And here's where the fraudulent documentation may occur. A provider reviews the record and decides to clarify his or her documentation by charting his or her version of events before the records are sent to the attorney. Knowledge of the outcome of an event results in very different documentation than contemporaneous documentation.

After-the-fact documentation may be OK if it consists of something like, "The patient suffered a stroke after the procedure," but most after-the fact documentation is self-serving, meant to put the healthcare provider in a better light. So instead of stating that the patient suffered a stroke after the procedure, the healthcare provider might write, "The patient suffered a stroke after the procedure despite getting the finest care from everyone. I discussed the risk of stroke with her in great detail prior to the procedure and she wholeheartedly agreed that her condition was so debilitating that she needed to proceed immediately."

Sometimes these extra notes aren't dated, giving them the appearance that they were written earlier. Sometimes the notes are blatantly backdated. Either way, the documentation is fraudulent. This kind of intentional spoliation of evidence can have serious consequences.

Before the lawsuit even starts, the plaintiff firm now has two sets of records: one from the patient and one from the firm's authorization. If documentation was added after-the-fact, it will become apparent on the second copy of the medical records. Cross-referencing by a legal nurse consultant working for the plaintiff will easily reveal any discrepancies in the medical records.

Defense firms may be unaware of any documentation discrepancies because their copy of the records is obtained after the lawsuit is initiated. The defense firm will just have one copy of the records - the altered copy. Legal nurse consultants who work for the defense, should be alert to multiple authorization requests from the patient and law firm. The defense attorney can request that the plaintiff firm provide the defense firm with any and all copies of the plaintiff's records received through authorizations so that the LNC can cross-reference the records and detect discrepancies. If there are altered records, at least they will be recognized early in the lawsuit.

Want to learn more about LNC skills for legal nurse consultants?  Check out the Archives.

...Katy Jones