It's already happened. I just want to know how to follow up with it with my provider first before I file a complaint with the state.
Call your state representative's office and ask for the document PDF or online reference? Found this here: http://www.statutes.legis.state.tx.us/Docs/PE/htm/PE.37.htm , but it's not necessarily MEDICAL. It's ANY type of record.
You might be right. It could be governmental record when it is submitted to the court, though. Sec. 37.10. TAMPERING WITH GOVERNMENTAL RECORD. [rquoter](c)(1) Except as provided by Subdivisions (2), (3), and (4) and by Subsection (d), an offense under this section is a Class A misdemeanor unless the actor's intent is to defraud or harm another, in which event the offense is a state jail felony. (2) An offense under this section is a felony of the third degree if it is shown on the trial of the offense that the governmental record was: (A) a public school record, report, or assessment instrument required under Chapter 39, Education Code, or was a license, certificate, permit, seal, title, letter of patent, or similar document issued by government, by another state, or by the United States, unless the actor's intent is to defraud or harm another, in which event the offense is a felony of the second degree; (B) a written report of a medical, chemical, toxicological, ballistic, or other expert examination or test performed on physical evidence for the purpose of determining the connection or relevance of the evidence to a criminal action; or (C) a written report of the certification, inspection, or maintenance record of an instrument, apparatus, implement, machine, or other similar device used in the course of an examination or test performed on physical evidence for the purpose of determining the connection or relevance of the evidence to a criminal action.[/rquoter] I'll call My Cousin Vinny.
I work in this field, actually. You can find loads of info here: http://www.hhs.gov/ocr/privacy/index.html
HIPAA includes, since 2003 the US Health and Human Services security rule, which, from the site, says: HHS published a final Privacy Rule in December 2000, which was later modified in August 2002. This Rule set national standards for the protection of individually identifiable health information by three types of covered entities: health plans, health care clearinghouses, and health care providers who conduct the standard health care transactions electronically. Compliance with the Privacy Rule was required as of April 14, 2003 (April 14, 2004, for small health plans). HHS published a final Security Rule in February 2003. This Rule sets national standards for protecting the confidentiality, integrity, and availability of electronic protected health information. Compliance with the Security Rule was required as of April 20, 2005 (April 20, 2006 for small health plans). OCR administers and enforces the Privacy Rule and the Security Rule. HIPAA has always been focused toward privacy and confidentiality of protected health information. However, the integrity of the record is very much a part of HIPAA and I'm quite certain the OCR would take up a complaint in the arena of falsifying medical records or otherwise committing PHI fraud. He likely could easily find an attorney happy to take up a civil suit as well.
Or, even if you put HIPAA aside, here is a precedent set in the mid-90s on the altering of medical records and the decision. http://biotech.law.lsu.edu/cases/medrec/moskovitz_v_mt_sinai.htm Also, most providers have their own internal means of reporting abuse and fraud. For example, Blue Cross Blue Shield has a fraud reporting functionality on their website, same for Medicare, Tricare, etc. Finally, you can file a complaint with the Attorney General's Office as well: https://www.oag.state.tx.us/consumer/health_care.shtml
You couldn't possibly expect to start this thread, seek advise, and not explain what heppened. Did you? Tell me what happened damnit!
Yeah, the vagueness is annoying. How do we know there was actual falsifying as opposed to miscoding of a procedure or diagnosis?
Ha, Sherlock wants to crack the case? There's nothing vague about it. I want to know if there is a law concerning falsification of medical records. It doesn't involve miscoding, it involves a nurse documenting that they performed certain duties for a period of time that they never really performed. I know for a fact that the duties weren't performed and its potentially quite dangerous for this to be happening. I've filed complaints about unprofessional conduct from this person in the past and she continues to be put in charge of care. I feel it's an unsafe situation and I'm not comfortable with it at all. So now I'm ready to pursue it further.
If any of those billings were Medicaid or Medicare related report it to either Hhsc.state.tx.us Or HHS.gov Just look for reporting fraud. You can also go to the attorney generals office
