Your analysis of medical records shows that a provider tampered with medical records. You have a healthcare provider or possibly a documents examiner confirm your suspicions. Here is what can happen next.

STATUTE OF LIMITATIONS

Tampering may extend the statute of limitations. Plaintiff attorneys who can prove that tampering has occurred have had some success in getting the statute of limitations extended under the premise that fraud has been committed. When the records have been destroyed, the plaintiff attorney can request sanctions against the defendants for failure to comply with orders to produce documents.

If a physician or a hospital or a nursing home cannot produce records, the plaintiff’s attorney can argue they were intentionally destroyed or lost because of conspiracy or fraud. A plaintiff is at a disadvantage in the legal process and should not be prejudiced because of the missing records when medical records are missing for unexplainable reasons. This puts the burden of proof on the defense.

SETTLEMENT

Settlement might become inevitable even if this case was otherwise defensible. If this case goes into the courtroom, the jury can be angered. The defense attorney of a provider who tampered with medical records can be very concerned about how the jury will react to the allegation, so will often make great efforts to settle a case.

PUNITIVE DAMAGES

Angry juries may award punitive damages to send a message to the defendant. Insurance carriers are not likely to cover punitive damages because they can’t insure their physicians or hospitals against their wrongdoing.

Many states recognize juries may infer that by altering or destroying evidence a defendant was trying to avoid liability. The judge may include a jury charge specifically related to the tampering of medical records. This varies from state-to-state.

LICENSING AND PRIVILEGE

It gets worse for the provider. Some state regulatory or licensing boards may investigate the healthcare provider, resulting in loss of license and inability to practice. The person who made alterations in the medical record may find that it’s impossible to get a renewal of insurance to continue to practice.

Another aspect of this is the shame of being exposed as somebody who has tampered with medical records. There’s a loss of reputation, guilt, and embarrassment. This can have a profound impact on an individual and the provider’s medical practice.

CRIMINAL CHARGES

Lastly, in many states falsification of medical records is also a criminal offense. It can be punished by fines or even incarceration. Loss of license is typically accompanied by being sent to prison for having fraudulent medical records.

A very unusual Pennsylvania case involved a licensed practical nurse (LPN) who worked in a nursing home. She was the first nurse in the United States to go to prison for falsifying medical records. She was prosecuted under the HIPAA regulations. The prosecutor said that because HIPAA is a federal program, you are required to maintain accurate records as part of HIPAA.

This event began when the LPN got a phone order to change the dosage of Coumadin. The LPN did not transcribe this order correctly, and the Coumadin continued to be administered at its previous level. The patient’s condition worsened; she was transferred to the hospital and ultimately died. The LPN falsified the medical record to indicate the physician’s telephone order had been implemented correctly. This is what got her in trouble, not the original error.

A typical nursing home medication administration record has medications down a left column and dates across the top. There are little boxes for initials for people to sign as they administer the doses. The LPN had to rewrite this whole medication administration record and falsify people’s initials in order to make it look as if the Coumadin dosage had been changed.

The prosecutor decided to take this case to send a message to healthcare providers. He maintained medical records are routinely falsified and if such falsifications are prosecuted as federal offenses, it will deter such behavior. The LPN was sentenced to 10 to 16 months in federal prison and lost her nursing license.