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A sign outside the Central Alabama Veterans Health Care System complex in Montgomery, Ala., reads, "Veterans, yes we will be open, " on Friday, April 8, 2011. If lawmakers cannot come to an agreement on the budget by midnight, there will be a partial federal government shutdown. (Montgomery Advertiser, Amanda Sowards) / MONTGOMERY ADVERTISER

WASHINGTON ?? By copying old information into patient records, a pulmonologist at the Montgomery, Ala., veterans hospital may have committed insurance fraud, according to an internal VA report on the case.

The Department of Veterans Affairs own medical inspector said the pulmonologist's actions might amount to falsification of a government document.

"If third party payers were billed for any of the pulmonologist's medical evaluations based on copied and pasted entries into the medical record, this could constitute fraud," according to the initial 2013 report from the VA's Office of the Medical Inspector.

The VA bills private health insurance providers for medical care, supplies and prescriptions to treat veterans' conditions unrelated to their military service.

After the medical inspector's initial report, further investigation found the pulmonologist at the Montgomery campus of Central Alabama Veterans Health Care System copied old information into patient records more than 1,200 times from 2011 to 2013, according to the U.S. Office of Special Counsel. The counsel's office ordered the review based on information provided by a whistle-blower.

The initial report, a copy of which was released by Congress this week with names blacked out, said the pulmonologist admitted to copying and pasting data gathered by other doctors such as patient history, vital signs, examinations, assessments and plans of care, into his own assessments.

"He acknowledged, in his words, that his 'technical incompetence' and 'stupidity' resulted in the inclusion of other's information in his signed notes," according to the report. It says the pulmonologist was interviewed about the practice in May 2013.

The case of the Montgomery pulmonologist has figured prominently in the national scandal over how long veterans have to wait to see a VA doctor, attempts to cover up the long wait times and how the delays affect patient health.

The Office of Special Counsel, an independent agency that reviews whistle-blower allegations, has highlighted the Montgomery case as an example of weak internal oversight of VA doctors and a failure to fully heed the concerns of VA employees who expose wrongdoing.

The Medical Inspector raised the issue of insurance fraud involving the Montgomery pulmonologist with the VA's Office of General Counsel, which referred it to the VA's Office of the Inspector General, the 2013 report states. The inspector general is currently investigating manipulated scheduling records at VA health facilities around the country, including at CAVHCS.

Rep. Martha Roby, R-Montgomery, has encouraged whistle-blowers to contact her office about conditions at the Montgomery and Tuskegee campuses of CAVHCS. She said the pulmonologist's case is evidence of a "no consequences" environment at the VA.

"The absence of basic accountability has bred a culture of complacency and our veterans are paying the price," Roby said Friday through a spokesman. "Anyone found to have been engaged in criminal wrongdoing must be prosecuted to the fullest extent of the law."

While the Medical Inspector concluded that the copying and pasting of patient records was a violation of VA policy, it could not substantiate whether the practice endangered patient health.

Special Counsel Carolyn Lerner told President Barack Obama in a letter last month that there is a troubling pattern in which Veterans Affairs managers deny that errors uncovered by whistle-blowers have compromised patients' health.

"This approach has prevented the VA from acknowledging the severity of systemic problems and from taking the necessary steps to provide quality care to veterans," she wrote.

Her office has asked the VA for more information to determine whether the unscrupulous record-keeping endangered patient health.

Lerner was also critical of CAVHCS leaders because the pulmonologist's copying and pasting continued even after he was caught. Even after being caught the second time, he was given only a minor reprimand.

Acting VA Secretary Sloan Gibson recently ordered a restructuring of the Office of Medical Inspector and named a new interim director.

"As we complete reviews and investigations, we are beginning to initiate personnel actions to hold those accountable who committed wrongdoing or were negligent," Gibson testified Thursday before the House Veterans Affairs Committee.

A spokeswoman for CAVHCS had not provided answers to questions about the pulmonologist's case as of Friday evening.



Copyright 2014USAToday

Read the original story: VA inspector says Alabama doctor's acts may be insurance fraud

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