A Georgia healthcare provider has admitted in federal court to ordering two employees to illegally alter documents during a federal civil investigation into alleged improper healthcare billing by the company.
The defendant pleaded guilty to one count of conspiracy to obstruct justice on June 5, 2024. She faces a maximum of 20 years in prison to be followed by three years of supervised release and a $250,000 fine. In addition, the plea agreement stipulates that she will pay restitution to TRICARE, Medicare, Blue Cross Blue Shield, Medicaid, and the US Department of Veterans Affairs (VA). Sentencing is scheduled for Sept. 5. There is no parole in the federal system.
According to court documents, the company, an outpatient rehabilitation facility with locations in Byron and Macon, was served with a Civil Investigative Demand (CID) requesting various patient records on Oct. 7, 2019. After its receipt, the owner set up a meeting about the CID with two employees. She told them it was an audit and explained that the company did not have the records that were requested. She then instructed them to go into the system and pull any portions of the requested files, looking for hard copies of the records in the company’s storage unit if needed.
Many of the requested records were either blank or missing. The owner explained that if the records were not there or had not been signed, the employees were supposed to create or sign the records. For example, if the records were missing progress notes, she instructed the employees to make them up by copying and pasting the narrative language from other progress notes to fill in the missing information. These narrative sections were supposed to contain unique information from each session, such as the patient’s pain level and what exercises were performed at the visit.
One employee expressed concern to the other employee that what they were doing was illegal and quit. The other employee complied with the owner’s instructions and added notes and signatures to patient records as needed. These doctored patient records were then produced to the Civil Division of the US Attorney’s Office on Dec. 2, 2019, in response to the CID. The owner now admits that she conspired to corruptly alter patient records with the intent to impair the integrity of those records and their availability for use in a civil action.
“Anyone who attempts to alter or destroy documents requested as part of a federal investigation will face federal penalties for breaking the law,” said US Attorney Peter D. Leary. “For the sake of justice and truth, it is imperative that the integrity of the investigation is maintained for the benefit of all parties.”
Compliance Perspective
Issue
It is illegal to knowingly alter, conceal, falsify, or destroy any record, document, or tangible object with the intent to interfere with a federal investigation or other proceedings. Examples of federal tampering crimes include making false entries in records, doctoring documents to hide illegal activity, evading taxes or other required payments, and altering or destroying documents in anticipation of a future investigation. Additionally, it is unlawful to require employees to engage in such criminal activities.
Discussion Points
- Review your policies and procedures related to record management. Ensure that policies explicitly prohibit altering, concealing, or destroying records. Verify that procedures guide employees on cooperating with investigations without fear of retaliation.
- Ensure staff understand the importance of accurate and complete documentation. Educate them on recognizing signs of potential tampering, and provide guidance on steps to take if they suspect wrongdoing, including the use of the anonymous Hotline. Also ensure that staff know what to do during an investigation and that they should cooperate with investigators. Document these trainings and file signed records in the employee education files.
- Conduct periodic internal audits to review recordkeeping practices and to identify any irregularities. Periodically audit staff understanding to ensure that they are aware of your policy of nonretaliation in the workplace and how to report any concerns.
*This news alert has been prepared by Med-Net Concepts, LLC for informational purposes only and is not intended to provide legal advice.*
