Secretary
Department of Health and Human Services
Hubert H. Humphrey Building, Room 615-F
200 Independence Avenue, Southwest
Washington, DC 20201
Re: Health Care in Florida and the US in the cases of the Elderly;
Reviews by the DHHS through HCFA:
A) the Florida Medicare PRO, FMQAI
B) the State of Florida's Health Agency, AHCA
C) the HCFA Regional Office in Atlanta under Mr. Eugene Graser
D) the Medicare insurance carrier: First Coast Service Options, inc.
E) Falsification of medical records generally
Dear Mr. Secretary:
This is a complaint about incompetence and fraud in the management of the Medicare/Medicaid program. If it is allowed to continue, the taxpayer is going to be saddled with a tremendous burden to the detriment of the public. Granted, there are major corporations and individuals in the health care industry, who will profit. Their gain, however, is at the expense of the American community.
You are the new head. You have a more than impressive background. I do not agree with all your policy choices, yet we have a fundamental basis in the love of the outdoors and an interest in the health of the nation.
I have a longwinded story. It is an over 2-year-crusade against the unbelievable state of health care under the Medicare program as I have intensively experienced it in Florida. Florida consumes the greater part of Medicare funds due to the elderly population. The experience, I accurately describe, deserves your attention, since it exemplifies the unethical waste of Medicare funds. In this case this waste also resulted in the questionable death of the patient.
I should not have to wage this crusade alone. I did not expect this. I anticipated that the health care control authorities would take over, when I pointed out the abuse. I was very mistaken. The health care authorities eased the way of Medicare abuse for the health care providers to the detriment of all patients - past, present and future. I'm sure, you agree : This must stop.
Background:
My mother, Zoe E. Stronstorff, died on 13 February 1999 in Bradenton, Florida in a Medicare paid SNF (skilled nursing facility) at the age of 88 due to cardiac and respiratory arrest. I was her legally designated health surrogate and was living with her prior to her hospitalization.
She had had a stroke on 11 January, which left her alert, yet with dysarthria (not understandable speech due to muscular problems) and with left hemiparesis. She was in the emergency room (ED) of a JCAHO hospital, Blake Medical Center, under the control of ED Dr. Liskiewicz from 12:48 until after 17:44 in stable condition, having only been consulted by a neurologist, John Malone. According to the emergency room doctor's report, Dr. Malone ordered an oral aspirin and D5 normal saline (The patient did, however, receive absolutely no hydration or nourishment in any form until 17:45 according to the records and my knowledge. (I was with the patient basically the entire time, having arrived in the ambulance with her).
She was then admitted to ICU with the express purpose of receiving the blood-thinner: heparin therapy. According to the neurologist, this was imperative if I wanted Zoe to survive. (I expressed my concern about Zoe receiving this anticoagulant, since I knew, she had been hospitalized with a blood coagulation problem at this very hospital previously. I was not informed by the doctor, but left with the unspoken choice: "heparin or death." I later discovered this therapy was contraindicated for several reasons including recent eye surgery.
No mention of pro's and con's were mentioned to the therapy. There was no informed consent to this treatment or to any other treatment option. Absolutely no information about CVA, stroke or treatment options were provided not only on this day but until discharge.
I believe, the heparin therapy was chosen to fraudulently admit the patient to the hospital under Medicare rules. [It appears the hospital chose a nonexistent condition {carotid occlusion, which would justify heparin use} for the fraudulent claims justification]. The patient was stable in the ER for five hours. No deterioration was expected. The patient could have been discharged home with home health care. I was willing and able to take care of the patient. (Even with Atrial fibrilation, initiation of coumadin/ Warfarin could have been started at home. The very fact that the hospital, after stopping heparin administration on 1/13/99, gave absolutely no blood thinner stronger than the proven insufficient baby aspirin indicated this).
This option (home health care), which would reduce unnecessary medical costs was not even presented to us.
Apparently, Zoe then had an adverse incident related to the heparin immediately on admission and initiation of the heparin. This is unclear, because the hospital records have been manipulated considerably to hide this. Enough is still left to prove that both the medical records and laboratory (CLIA) requirements have been massively violated on both federal and state levels.
Somehow the records of the afternoon treatment in the hospital under ER doctor Liskiewicz were replaced (for Agency and PRO reviews) with records of an unknown ER doctor Silpa (I assume this is the ER nightshift doctor). [In the meantime Dr. Silpa has purportedly written that he never saw the patient; that it was a medical records problem with "Blake hospital". Yet his name appears clearly on Medicare Part B claims as both the emergency room physician (ICN - 52 904 22932 900). The records of the patient living at home with me and my existence seemed to disappear from the ED visit under Liskiewicz and the "questionable care" of Dr. Silpa.
Apparently according to the records containing the claims payment justification given to 1) FMQAI, 2) AHCA and 3) First Coast Service Options, inc. there are records of Dr. Silpa and the patient becomes "unresponsive" and later "aphasic." [I have, however, seen references to "aphasia" in the EMS ambulance report. However, from my acquired knowledge on the subject Zoe at no time was aphasic. The Blake Medical Center Speech Pathologist also stated this in his records already on 1/12/99]. It is a fraudulent diagnosis.
The attending doctor, who was an "Arrojo," sometimes becomes a "Polanco" and sometimes the two different ER doctors and at least two other doctors ("Braxtan" and "Malone" and now [ June 2001 through review of First Cost Service Options, inc. Medicare Part B computer printout] possibly the name of some "psychologist" could be found in the justification of care).
Only two actual laboratory tests (requisitions w/ fraudulent data - wrong patient location dated 1/11-1/12/99) were found in the Medical records on 28 April 1999. Later even these two disappeared. On 3 February 1999 there were some summary laboratory tests from 1/11/99 and 1/12/99.
By 28 April the summary laboratory reports (although dated 3 February with an earlier time (0745 as opposed to 1016) lost all tests through 1/14/99 (exception 1/13 for heparin PTT tests).
There is proof that tests had been ordered [ Physician's Orders], yet apparently these tests along with others, which would document lack of medical standards of care, were simply suppressed. If no proof of the damage is available, then one has no evidence and no action can be undertaken. At least nothing happens under the current control of the authorities mentioned in A, B, and C above.
Following this adverse incident (I only heard about it on 1/12/99, when I was told by Ms. Sarantos (AHCA) that Zoe had come into the hospital at night on 1/11/99 and that the heparin therapy began on 1/13/99. This is of course untrue, yet apparently these are the records, which the 28 June 1999 survey acquired. The Agency, however, obtained the same set of records, which I have to take back for further review (pharmacy).
Zoe (possibly underweight) was starved for three days (intravenous normal saline was the only nourishment [18 grams of salt and no nutrition]. (FMQAI informed me that this was "optimal care."). [From the description of the care, it is clear that they did not have the same medical records, which I had, although in my records there is the mention of D5 normal saline prescribed in the ED, but this the patient never received.]
Without proper testing for swallowing difficulties (No barium video test was given until a full two weeks after admission) a nasal feeding tube was inserted on 1/13/99. (I was not present for the swallow test. I was never informed that there was any other choice than the nasal tube or the PEG operation. The pressure from both the neurologist and the primary doctor (Arrojo) for an immediate PEG operation on the morning of 1/12/99 was great even prior to any type of swallow test . I now know that at this time Zoe's heart was damaged and her blood much too thin to have had an operation at this time).
Without being informed of the apparent cardiac problems or of other options such as feeding with care, I consented to a nasal tube in the event that Zoe failed the swallow test. No nasal tube was, however, inserted for another day and a half. The blood-thinning heparin, however, was continued on January 13th along with coumadin. Then (after the refusal of the Peg-operation and request for the nasal tube) a diuretic (Mannitol) was prescribed against the warnings and precautions of the drug manufacturer.
On January 15th, it is written into the Physician's Orders: "daughter not allow to review chart." This is an obvious violation of state and federal law. My mother was blind, and I was not only her daughter but also the legally designated health surrogate, which was entered into the Medical Charts already on 1/11/99, before any medication was given in the ICU, where the patient was in stable condition after five hours in the ED (emergency room/ department).
Zoe came down with pulmonary edema and CHF on the evening of 1/16/99. I discovered it myself. The nurses had not noticed the fluid buildup (only "symptomatic care" was ordered and not "strict I/O). The nurses' notes have been removed for 1/16/99. I thought because of the documented problems, yet two consultations for a transfer to Subacute or an SNF were also made on this day along with a consultation of a doctor to replace the "fired doctor "Arrojo."
On this day my mother was pivoting with the aid of two nice nurses and was recovering quite well now that she was getting some nourishment (The last three days were only salt and water). This information apparently had to be suppressed. Zoe was supposed to be transferred out of the hospital. She was not in need of any acute care. Yet the ensuing events (pulmonary edema, CHF, renal insufficiency) kept her in the hospital. These new events were not a result of her stroke.
The cure for the "temporary fluid overload" or "bronchospasm" (not CHF) as described in my medical record's copy was the diuretic (lasix plus the continued overdose of Mannitol and zero fluids). This ruined the patient's kidneys and put her in highly critical condition for the next four days (January 17, 18, 19 and 20). This is hardly mentioned in my copy of the medical records. On the 20th, the first official cardiologist appears on the scene - nine days after admission. (It appears that Blake Medical Center or alias "HCA L.W. Blake Memorial Hospital" alias "HCA LW Blake Hospital" submitted fraudulent records to justify Medicare payment and to document medical necessity and quality of care.
That the documents are fraudulent is known by all three organizations and by the HCFA Region IV office. The horrendous care Zoe and I received is reflected by this permissive attitude that allows fraud and massive violations of the patients rights to go unpunished. HCA submitted one claim in February 1999, which was paid and then submitted another after the PRO review with possibly more diagnoses in May 2000. To date despite many requests for the information about the claims, I still am in the dark. This is the health care system intention.
These complications are not shown in the diagnoses of the hospital doctors, however, other fraudulent diagnoses are. The records and reports are manipulated to not show any hospital mistakes. The treatment of the patient was ordered to cover the mistakes without any regard to the patient's wishes or true condition.
As already mentioned laboratory reports are suppressed, possibly even changed to hide hospital induced problems. The Physician's Orders in my possession and on last viewing at the hospital clearly show laboratory test having been ordered and declared pending, which never appear in the laboratory summary reports (as mentioned earlier - not one real laboratory report is now found in the medical records. I was told by Ms. Stone, Blake Medical Center Health Information Management Director, that they have no other records. Should this not be a deficiency in the Medical Records CFR requirements?)
During this time that Zoe was in highly critical condition (kidneys 1/18 -1/22/99), Zoe was actually scheduled to be operated on for an unwanted and unnecessary PEG operation. It appears the operation was wanted without having a barium video x-ray swallow test, which would document that this operation was unnecessary.
I now suspect, seeing the pressure exerted on me to allow the operation during times, when Zoe was "highly critical", that her death was desired (The unreported medically induced adverse event on admission evening appeared to have damage her heart and possibly caused bleeding and a new brain clot). If she were dead, there would be no legal recourse for the damage caused by the hospital (Zoe's heart was documented by the telemetry of the ambulance at 12:48 on 1/11/99 as having an irregular heartbeat. The two heart monitor strips of 1/11/99 at 22:04 (almost flat lined) and then on 1/12/99 at 11:35 totally irregular heart rhythm seem to document a new problem.
The ambulance telemetry report of her ambulance trip to the hospital was missing from the hospital records. The EKG made before her death at the nursing home, where she died, is missing from the records and the telemetry of her heart, which was sent to the hospital at her death was "inadvertently" shut off.
Despite the horrendous care at the hospital, Zoe was recovering. In fact she was well enough that I was able to take her myself in a wheelchair outside for lunch (January 26th in the Physician's Orders). Several physicians document that since I refused to consent to the PEG operation and also refused a proposed "psychologist evaluation" of my mother, there was no reason to keep her in the hospital. (Either home health or a SNF (skilled nursing facility). I was never told of the option of "home health."
In any case Zoe remained at the hospital from 1/26/99 until 2/2/99 at Medicare's expense, although the HMO physicians had suggested in the Progress Notes that she be discharged. [It is possible that on paper, she was discharged, however, there are enough witnesses to the fact that she was actually caged in the hospital and then in the nursing home until her death was achieved.
Had I been offered "home health care," I would have jumped at it. I was at war with the hospital since I was denied access to my blind mother's medical records on 1/15/99 (violation of the patient's rights found documented in the Physician's Orders) and the discovery that Zoe had received zero calories and 18 grams of salt per day in her intravenous fluids for the first three days of hospitalization (normal saline -1.8 liters per day. Two nurses have written in the medical records that they told me that the hungry, underweight and protein deficient diabetic was receiving all the nourishment, she needs. At this time I was unaware of the other solutions available including a normal saline with one half the salt (D5 1/2 NS). I was also unaware, that eating with care is normal for stroke victims. Most stroke victims have swallowing problems, but Zoe's were minor.
Zoe was then discharged to a nursing home, although she was ineligible by Medicare regulations. She had been ambulating and I was available to provide custodial care. Therapies could have been prescribed at home. It appears, Zoe was put on iv-medications (some had already been discontinued and were restarted, when the neurologist had discontinued it), which could have been given orally. Zoe was discharged to the SNF for basic custodial duties. This was the documented goal of the attending physician without any regard for the patient's or my wishes.
Insulin was prescribed sometime after hospital admission, (when is unclear since although Zoe was non-insulin dependent on arrival at the hospital. Insulin has been determined to increase the possibility of having another stroke. It appears this is why Zoe was left on insulin. She was insulin intolerant and was having no better sugar readings with insulin than without any medicine at all. It appears, that no effort was made to improve her survival chances. (Insulin increases the clot danger of stroke victims). It may also have been left as a means of justifying hospitalization.
Zoe had a catheter forced on her as one of the first actions in the ER on 1/11/99 (against the FL stroke guide lines and almost every other literature). She was alert and continent. No attempt was made to remove the catheter, although Zoe requested it's removal several times (The first time on admission night at about 1800 hours on 1/11/99. After the events of the 16th (pulmonary edema, CHF) and the following near coma condition (18, 19 and the 20th "undocumented" renal failure) her skin in the peri area broke down.
At the SNF I wanted to remove my mother immediately from the SNF after seeing abuse by a nurse's aid. At this time I was talked into leaving her there until she could be weaned from the catheter. The day before her death, I was told she could be discharged with the catheter.
Danger of a skin breakdown on arrival at the hospital was near zero (Critical Care Flow at 1800 on 1/11/99). One week later with the Medicare funded care it was a horrible actuality.
Interesting is that on my requested audit of the hospital bill, the "ambulation" of Zoe was removed as a charge. There was no reason to remove it. I have the records, which show the ambulations occurring. Zoe was capable of bearing her weight and walking a few steps before discharge. However, if Zoe were discharged to the nursing home, she would not be eligible for Medicare funding at least not in that category, which she was placed.
The discharge of Zoe was Medicare fraud. She was stable. The care given at the SNF was basically custodial. The speech therapy, she received at Integrated Health Services of Bradenton was basically just feeding her. I was a witness to this. ( I have my mother's handwritten notes and I have at least three other unrelated witnesses to this fact).
Zoe was allowed to die from the evening of 2/11/99 until late afternoon on 2/13/99. She had the textbook symptoms of saddle embolism, which was not officially diagnosed although a sonogram to rule out deep vein thrombosis was ordered by the physician (Unaeze) at 0610 on 2/12 according to the symptoms called by the SNF nurses via telephone. At 0635 he called back and canceled the order and ordered a hip x-ray (Zoe had fallen 4 days previously and had no pain from this). The x-ray was ordered "STAT" and took according to the company x-ray report over seven hours to arrive. The x-ray reported no damage to the bones or soft tissue.
At 1330 hours the doctor showed up and moved her legs. Zoe could no longer move them herself. The legs were like ice and mottled in color. The doctor prescribed Darvocet (It had already been prescribed by his partner the night before and was obviously not working) and left the facility. The symptoms were clearly those of a blocked artery or vein.
After continued concern, the doctor ordered a CT-scan without contrast (According ti the Order in the IHS Physician's Orders, it was ordered "STAT." IHS apparently faced the hospital at 1500 hours, yet the CT-scan was scheduled for three hours later by Blake Medical Center, although they fraudulently show admission at 1500 hours.
However, the records at the hospital have statements of a "Physician ordered" and of an "elective status - not urgent and not an emergency." It appears she was supposed to have died already before the spinal CT-scan) for a supposed hip injury.
Zoe was transferred to the hospital for a Medicare-paid spinal CT-scan and then returned to the nursing home. However, according to the Blake Medical Center records, Zoe was released "home." [sic. The same ambulance and crew, which brought her to the hospital with a "CVA is suspected," also returned her to the same SNF].
This test was not for the obvious critical condition of the patient. Emergency care was denied by Blake Medical Center, the doctor (Unaeze), and the nurses at the nursing home (Integrated Health Services of Bradenton).
(The Ambulance report showed no pedal pulses and a non-reactive eye and that the patient was in extreme pain and that the urine in the catheter was cloudy. These reports were missing in the SNF medical records. The SNF nurses' reports do not mention this).
The nurses continued documenting the pain, the discoloration, the temperature and the moveable mass in the back. The doctor was informed and zero action was taken until she stopped breathing on the late afternoon of 2/13/99. Then against the patient's living will CPR was given. (I guess some action had to be taken to show, they tried to save her life). The medical records, I received show that the patient was discharged at 8:38 on 2/12/99 [sic. She remained at the nursing home with the non-emergency care interlude until her death on 2/13/99 - never even receiving an adequate painkiller].
The doctor failed to either provide the emergency care, which was obviously necessary from the morning of 2/12/99 0610 until her death at 1545 on 2/13/99. The IHS nurses allowed Zoe to cry out most of the night of 2/11-2/12 before contacting a physician at 0600 in the morning of 2/12/99.
The nursing home actually falsifies the discharge date and their records to show discharge on 2/12/99, apparently to hide the ambulance records, which document Zoe being in worse shape than the nursing home records show and her death there on 2/13.
The nursing home also falsified the records to show an ENT (ear nose throat) doctor's consultation in house, when Zoe was sent alone to the specialist by ambulance taxi on 2/9/99. (The fact that she could be sent alone by wheelchair taxi, showed that she was not eligible for Medicare at a nursing home). I also took her home in my own private car on Sunday. Zoe was delighted to be at her own home. The ENT specialist (In the Medicare bill, he is shown as being referred by a doctor, who is 100 miles away from Bradenton - a fraudulent name).
I believe Zoe was deliberately allowed to die. In fact, I believe she was purposely neglected:
1) no blood thinner stronger than a baby aspirin was prescribed although it was known that this amount of aspirin was not sufficient to have prevented the 1/11/99 stroke.
I believe in the falsified records (known to be falsified by both FMQAI and AHCA) there appears fraudulent statements to Zoe's having been given coumadin. Zoe, other than possibly on 1/13/99 never received any coumadin unless on paper. The standard of care for AFIB with a history of CVA was not met.
2) magnesium and potassium deficiencies were not corrected although this is extremely important for heart rhythm disturbances. No mention of this deficiency was made known in the discharge to IHS.
3) The EKG was ordered and performed on 2/9/99, yet has disappeared. It appears that an effort has been made to destroy all documentation of the heart condition immediately before and during the hospitalization.
4) No action was taken to save her from 2/11/99 when excruciating pain and a cramp in the right leg with blanching at about 20:00 hours until her death at 15:45 on 2/13. The ordering of a CT-scan without contrast for the symptoms of saddle embolism (and after an x-ray had shown no damage) is a rip-off of Medicare. (The hospital forced me to sign an ABN, and still possibly First Coast Service, inc. paid the bill. [ I say still because I have an MSN that said it was paid in full, yet I have the suspicion that First Coast Service, inc. (the Florida Medicare insurance carrier has sent me fraudulent statements)].
A) the Florida Medicare PRO, FMQAI found nothing wrong with my complaint about starvation for 3 days, pressure for the PEG operation, and unmonitored fluid overload and damage to the kidneys. (They apparently received laboratory reports starting on 1/15/99 (admission 12:48 on 1/11) for their evaluation - also a report from Dr. Polanco, the partner and not the attending Physician and a report by Dr. DeGroat, a cardiologist).
I believe the report by the cardiologist may be fraudulent since he mentions admission medications in a consultation report and has according to my knowledge not seen the patient before 1/20/99 - nine days later. FMQAI made their "no problems" decision on March 5, 1999.
The lack of laboratory testing did not bother FMQAI. Later, when I added the complaint about heparin (starting on 1/11/99), FMQAI was perfectly happy to investigate with only laboratory tests from 1/14/99.
See no evil, hear no evil, speak no evil.
FMQAI has ignored the obvious impossibility of two different justifications (one must be false) for justification of care for the same case by allowing different records to be used; investigative PRO time limitations to expire and the submission of a new claim without a single finding of wrongdoing. It apparently did this by using the name "Columbia Blake Medical Center" for the decision of March 5, 1999 and "Blake Hospital" for their decision of October 13, 2000. Look at the time span. This is all the same investigation only fraudulently and conspiratorially reported. For your information, there is no "Blake Hospital" in Bradenton, Florida. Today the only legal name is Blake Medical Center. ("HCA L.W. BLAKE HOSPITAL" expired as a fictitious name in 1997. The use of a nonexistent name in this official Medicare PRO review can only be considered an effort to use fraudulent medical records, which it knowingly did. Do you think government funds should be spent on an investigation of a hospital, which does not exist?
Is this the kind of investigation the DHHS expects?
B) the State Health Agency, AHCA also found nothing wrong with my complaint about the heparin problems, which the hospital just suppressed. They, too, investigated "Blake Memorial Hospital," which does not exist. The unannounced inspection was on 28 June (?) and it found no substance to any of my allegations. (They apparently used records of the nonexistent hospital for the survey, yet had no problems ignoring the different record, which they picked up at the real hospital: Blake Medical Center.
In order to find no violations, they ignored my submitted evidence of the heparin problems (The laboratory summary report of 2/3/99 at 10:16 and the phony one found on 4/28/99 backdated to 2/3/99 at 7:45). The first summary showed late and defective reporting. The second showed suppression of the critical laboratory tests per se.
I also claimed suppression of further tests and falsification of records, including false reporting by the nurses.
In order that AHCA would not find anything, they apparently ordered that the medical records should not be reviewed and no violations of state or federal law should be pursued.
At the time of the complaint, I was unaware of "code 15" incidents and the significance of the CKMB value in the cardiac injury profile. AHCA was surely aware of this, but apparently had no desire to find an unreported "code 15" incident. Consequently, they just did not investigate, where they would have to find something to cite.
I was also unaware that the red markings on the left side of the medical records (Physician Orders) did not belong there. Actually they (hospital) marked in red everything that was wrong and should apparently be removed, rewritten, edited out, changed. (EO MT UT UP -? Edit out, mark test, unfavorable test, unfavorable prescription, also a mark like a straight vertical line with a check or the letter "K" for kill [get rid of]).
AHCA supposedly performed a laboratory review (CLIA) at the same time in June, but I am not sure for what purpose. There is a "not in the scope of this evaluation" written on the report. The missing laboratory tests of the heparin therapy time (1/11/99 - 1/13/99) was apparently not addressed. (In any case AHCA did not ask the hospital about the missing labs until after the 1 December 1999 meeting with Ms. Sarantos (AHCA's "integrity" officer), and was perfectly content with the hospital telling them that I, the patient's daughter, had "inadvertently" removed them along with another pertinent record .(This is impossible: How could I remove them and replace them with the others? This is a computer printout). The hospital's story of incomplete labs: the computer only printed out 20 days of hospitalization, but the hospital had corrected it and were monitoring it is even more unbelievable).
Everyone should know that all laboratory tests are supposed to be in the records (federal and state laws). Any programming to cause less than complete printout of the tests has to be physically and with effort programmed. The phony printout showing less data (2/3/99 at 7:45) actually showed less data than the later 2/3/99 printout of 10:16. This was intentional concealment.
AHCA by regulation was to interview the complainant (never done) and report the complaint to JCAHO - also not done. The UB-92, according to my MSN and the records of First Coast Service, inc. show Blake Medical Center submitting their claim under the fraudulent name of HCA L.W. Blake Memorial Hospital. It is possible that it is under this (possible non-profit auxiliary), it also maintains fraudulent records to justify the care, which the patient never received. My administrative appeal to AHCA for an administrative hearing was rejected on standing, and is now in the district court of appeals. Violations of administrative procedure occurred en masse.
The Agency has ignored evidence
C) the HCFA Regional Office in Atlanta , Mr. Eugene Graser was notified by my letter of 29 March 2000 about AHCA's ignoring the violations of the of Conditions of Participation- Part 482 Subpart C -Basic Hospital Functions Sec 482.24 Medical records Services. 18 pages of documented violations in this particular case. Mr. Graser did not even acknowledged the requested "receipt" until 28 February 2001 after numerous telephone calls to the Atlanta office. To my question if the medical records requirement were no longer part of the code of participation in Medicare/Medicaid, he still has not answered.
D) First Coast Service Options, inc. is supposed to make sure that the claims are properly filled out and watch for fraud, yet it does not catch the fact that claims for Blake Medical Center are not properly using the only legal hospital name: Blake Medical Center [ also the fictitious name Columbia Blake Medical Center was at least registered in Florida]. All other names are not in the AHA list of hospitals or in the HCFA list of providers. Provider code 100213 is for Blake Medical Center: HCFA <MEddinger@hcfa.gov>: "The provider #100213 is for Blake Medical Center in Florida. They are owned and operated by the Health Care Association, the actual name of the facility is Blake Medical Center."
They did not send me all the documents requested in my FOIA of 1999(certified/return receipt received on March 17, 2000 and ignored) or the current one ( December 29, 20000 - #4105900492). They have not sent me all the MSN reports, which have been made, and they have passed on bills, which were not allowed under Medicare to the private insurer: APWU Health and not passed on some (paying the bill at 100%, when the private insurer would pay 20%).
It is my sincere belief based on the treatment and information, I have received to date that the insurance carrier First Coast Service Options, inc. is actively defrauding Medicare : guilty of obstruction of justice, favoritism to Blake Medical Center and possible violations of federal and state laws requiring the recovery of illegal payments and leveling of fines for Medicare fraud.
I am enclosing the UB-92 forms sent to me by First Coast Service Options, inc.. They show tremendous discrepancies between what is and what should be. The documenting field by field complaint is given.
The computer printout is also documented. The apparent manipulation by this HCFA contractor on this 43 page form is unbelievable. The field manipulation might not be readily visible by someone, who has not been versed in computer programming/analyst work. I have however excelled in this branch: computer systems analyst, when I worked with "top secret" security clearance for the US government 25 years ago. The printout submitted to me is in itself a scandal.
To put out a list in this manner shows tremendous manipulation of the data before actually running the program. The true identity of providers should not be identifiable in this printout. If the original was in this shape, one must say, this carrier cannot possibly be fulfilling it's duties to the Medicare program. The claim would have to be rejected.
The request for the original claim of Blake Medical Center has still not been met.
The statement:
"Note this claim was not paid. It was cancelled and replaced." [Found on page 1 of the new DRG] is false.
It was paid by Medicare as an inpatient payment (I/P PMT) on 3/1/99 (according to Blake Medical Center's accounting information) and by APWU health Plan on 2/25/99.
The replacing claim was not made until May 24, 2000 (according to Blake Medical Center's accounting information dated 08/08/00. According to First Coast, it was made on 5/16/00.) Perhaps the new claim was made with the aid of FMQAI, the Florida peer review organization to meet the Medicare quality and necessity requirements.
Factual is that the claim was paid and that the diagnoses changed. When Zoe was discharged to IHS on 2/2/99, there were only three diagnoses given: 436 CVA; 427.31 AF and 250 DM.. At some time thereafter the records were altered to justify the claim. In the new May 2000 claim ten diagnoses are given and Dr. Silpa (the supposed admitting emergency room physician) says that it is a medical records problem.
This is fraud and a violation of discharging the patient without the necessary diagnoses and medical information to continue necessary treatment. In any case it must be cited to avoid such disasters as are shown in this case: unnecessary painful death and milking of Medicare without any penalty to discourage such behavior.
E) Falsification of medical records generally:
It appears to me now after having witnessed the care (actually lack thereof) of my mother at the hospital and SNF, that it seems to be a very acceptable procedure to be negligently treated and mal practiced to death in the case of any unmarried person without dependents, especially the patients on Medicare.
Zoe had to die because had she lived, she would have been able to sue for the damage to her heart and the incredible abuse of her rights, including the torture of denying her food and release home with home health care.
She would also have been proof to the fraudulent treatment, she received under the Medicare program. The latter would involve criminal penalties under the false claims act.
Blake Medical Center and many of it's medical staff including the "doctor of the year: DeGroat" would be in trouble. It also involves the now in Chapter 11 bankruptcy court Integrated Health Services. IHS check Zoe out a day early on paper and apparently went along with the abuse of Blake and Dr. Unaeze without reporting it as what it was: abuse and negligence of the elderly.
For the true record: Zoe was for her age extremely healthy. This fact was simply thrown out. Everything was normal because of her severe stroke and her age of 88 years. The diagnoses were made worse and medically induced complications simply overlooked. Records were simply suppressed, eliminated or rewritten to document, what would justify the bill and the patient's death.
It appears, Zoe as an 88-year-old had no right to proper care. It seems that her age was an excuse for any problem, which was medically created. This is age discrimination.
Zoe was relatively healthy when she arrived at the hospital. She wanted to live; her mother lived to be 105. At the hospital she had her health systematically undermined. At first in the name of profit:
Fraudulent admission of a stable patient to an empty hospital bed with the contraindicated heparin. Here there was no informed consent. None about this particular therapy (heparin) nor about the stroke per se nor about treatment options.
I felt that the reason for the push for the peg operation immediately on 1/12/99 before any swallow evaluation was profit. (In other hospitals a swallow evaluation is done immediately by a nurse. The records show that the neurologist had prescribed an oral aspirin in the Emergency room, which means this experienced stroke doctor thought there was no danger to swallowing the day before (on 1/11). Aspirin is available as a suppository. Had there been a danger of swallowing, he certainly would have prescribed it appropriately)!
I now feel that her death was desired. Had Zoe died in the immediate operation on the first morning in the hospital, the hospital would have had a signed consent form and no one would have questioned the death of an 88-year-old stroke victim. They would also collect the money for the operation. Unfortunately, I was not informed of the adverse medical incident on 1/11-1/12/99 and also knew nothing of Florida laws, which forbid malpractice suits for victims without a spouse or dependents under 25 - basically most Medicare patients. Had I known, that Zoe was eventually going to be mal practiced to death, I may have allowed the "euthanasia operation" to spare Zoe [and me] from the incredible torture of the next month.
It seems incredible that the amount of violations of basic standards of care is just plain negligence (FMQAI called it "optimal care"):
1) zero hydration for the five hours in the ER (one among several violations of the FL stroke guidelines). This was surely plain unintentional negligence, possibly caused by an understaffed hospital.
2) heparin is started although contraindicated in this particular case (This was standard malpractice to justify hospitalization. I feel it is time that this dangerous procedure be discontinued, since it has never been proven beneficial for stroke)! That I and Zoe were not informed of the value of this therapy, I find a violation of the patient's right to informed consent.
I questioned the allergic reaction of the patient "thrombocytopenia." I received not a one word answer. Had I known of the further contraindications: recent eye surgery and large clot hemorrhaging complications, plus the standard fact that it was considered by the majority of medical publications of being of questionable value, I would have surely declined.
3) no nourishment (only normal saline for 3 days, when malnutrition was identified on admission - the dietitian reported this. The laboratory test is missing, but must have existed for the dietitian to make an evaluation on 1/13). Either there was a suppression of the admission laboratory tests or there were defective dietary services at the hospital. I am not sure if this was not intentional neglect. On the morning of 1/12/99 the patient and I rejected the PEG operation and said that we would accept the nasal tube in the event of failure of the swallowing evaluation. No other choice was given: nasal feeding tube or the gastrointestinal peg operation.
The patient was apparently not eligible for either without a proper evaluation : a barium video test.
However, this test was apparently undesired because, it would show that the patient could eat solids. This test has apparently disappeared. This test was not made until two weeks after admission. I had to fight for it. A PEG operation had been scheduled more than once without our consent before this swallow test.
4) Insulin was given, when studies have shown this increases the chance of clotting after a stroke The emergency room doctor wrote that an oral pill should be given as ordered by the attending physician (Arrojo by phone?)
a. Rasulo, an endocrinologist was ordered by Arrojo for me, because I wanted to fire Arrojo on 1/14/99. Rasulo's handwritten report of 1/15/99 is missing and he never again returned to the patient after this one consultation, although Zoe's sugar was never brought under control any better than with normal diabetic pills, and insulin would make her insulin dependent. It appears this was the exact intent of the hospital - set the patient up for institutionalization! Money for the health care industry.
5) Dr. Braxtan, nephrologist, was also called in by me on 1/17/99. I begged Dr. Jose Polanco to let him come, because, I thought Jose was killing my mother with his incompetence. In my copy of Zoe's records and to my face, he never admits pulmonary edema and CHF, but apparently in the records submitted for Medicare payment, he uses this code. Zoe had pulmonary edema brought on by unmonitored Mannitol and her protein deficiency and lack of adequate input / output control along with the continued use of the intravenous normal saline solution, which introduced 18 grams of salt into her diet.
The "aspiration pneumonia" which appears in my copy of the medical record is not found documented in the x-rays. Except for the severe fluid overload: pulmonary edema, no signs of pneumonia were ever observed in reality. This code is also not given in the diagnoses in the last claim. My copy of the medical records show the deceit, which was carried on for my benefit to put pressure on for a profit-making operation without any basis for aspiration or pneumonia. The phony copy of the medical records used by FMQAI, AHCA, and First Service appears to document need of continued "acute condition medical need" the patient was unnecessarily abused at Medicare expense. (I have to date (despite a court order) been denied this copy of the records. At the same time, I have been denied the records for the billed coronary care, which is found in Medicare investigation records). The extended oxygen and respiratory therapy was only a "rip-off" of Medicare.
The laboratory reports document the highly critical condition of the patient after the pulmonary edema "cure" although no code for renal insufficiency is found in my copy of the medical records and I am aware of no special care for her kidneys other than "water fasting." At this time the operation for the Peg was again scheduled without consent. Zoe received no special treatment, which appears to have been billed to Medicare = fraud known to all parties and not reported.
6) Extreme psychological pressure was exerted on me to allow a PEG operation (gastro intestinal tube). When I refused again, I was almost manipulated into a "psycho evaluation" of Zoe. In reality the Physician's Orders show no such evaluation, because I rescinded the order about one hour later (In the Physician's Orders, this was called to Dr. Arrojo and he approved of the cancellation). However, judging from a diagnosis code in the ambulance transfer from the hospital to the SNF on 2/2/99 (This claim was not submitted until after it would no longer be eligible for payment this year.), on paper it appears Zoe (Medicare was billed for some treatments[?])! Aside from the unnecessary expense, it is possible that the facility and doctors hoped to hide documentation from the family.
To date, I have not received all Zoe's medical records and still do not know exactly what happened to her on admission night. Only one thing is certain, an honest effort to hide the facts of Zoe's care has been made. This concealment is approved of by HCFA on down. This alone is a scandal. I do know, that whatever accepted justification for the Medicare bill is fraudulent.
7) The transfer to the nursing home was in itself an abuse of Medicare. If one reads the medical records available to me, the intent of the attending Physician (Arrojo in my records and to my knowledge) was to 1) give her a stomach tube operation and 2) transfer her to an SNF.
What the patient or family wanted did not matter. That both of these intentions were more costly than a discharge home should be clear to everyone. Where are the patient's rights, which in this case were in the interest of Medicare?
The care Zoe received in the understaffed nursing facility was substandard. As usual the facility was hopelessly understaffed (normal by state and federal law). The discharge of Zoe to such a facility, when family was available to care for the patient is criminal or at least should be.
8) I have just received the records of the last day of Zoe's life: Zoe was denied emergency care by the hospital (Blake Medical Center) and the attending Physician (Dr. Vitalis Unaeze [on call for Dr. Sharma]) at Integrated Health Services of Bradenton (IHS).
The recognized symptoms of DVT (blood clot) were ignored after an emergency order was made to the hospital for a sonogram to check it out. This emergency call was made at 6:10 AM on 2/12/99.
Actually these symptoms are documented in my copy of the SNF medical records as having been present the night before - acute pain; patient crying out most of the night. At 6:45 AM without having the test, the sonogram was canceled and an immediate "STAT" x-ray was ordered (for a four-day old fall, which had been checked out) , which took over five hours to arrive at the SNF. The x-ray showed no damage to bones or soft tissue.
Thereafter nothing was done except a according to the SNF medical record, I have, except a "STAT" no-contrast spinal CT-scan was ordered. However, now I have received a copy of the hospital records for the "outpatient" and there it states that Zoe was referred to Blake by a physician (Unaeze) and that it was not urgent or an emergency but "elective" (lots of time to schedule) and that the patient was transferred "home." [sic]
The patient was returned to the SNF with the same ambulance and crew that brought her to the hospital approximately 24 hours after the symptoms of an embolism had started , yet the hospital and physician pretend that the "circulatory problem," which was clearly identifiable at 6:10 AM is now a minor "slipped disk" and Zoe was returned to IHS to die.
No action was taken until she stopped breathing at 3:20 PM the next day on February 13, 1999.
In conclusion, Mr. Thompson, I request you to please investigate these major Medicare in-house problems exposed by this tragic case of my mother.
Hopefully, you will continue your Wisconsin cost-saving measures in this position of major responsible. Your rule will affect the health and lives of millions of Americans. It is a great responsibility. The permissiveness of HCFA's Medicare/ Medicaid carriers and contractors is indirectly responsible for Zoe's torturous death.
Had the health care providers feared any kind of control by the authorities, they would have surely acted in a more humane and responsible manner. They, however, had no fear and expected to just rewrite the records to justify payment and if they get caught: cancel and file a new claim without any kind of penalty. They just file a new claim over a year later and everything is forgiven. STOP MEDICARE FRAUD is a joke as exhibited here. Every one profited but the patient. Is not the patient supposed to be the most important factor in the Medicare/ Medicaid program?
FRAUD appears to be the basis of the system as shown here.
It is with great regret that I saw your appointment of Ruben King-Shaw, jr. To the position of deputy administrator of HCFA. I had dealings with him in Florida and I question his integrity.
He seems to have personally arranged for the fraudulent alteration of official documents to show that AHCA had taken action in the case of Zoe Stronstorff. (Ms. Gallagher wrote that it was just a harmless error. Harmless errors do not change dates and document numbers and departments). Please see http://spcp2.homestead.com/kingshaw.html for the actual altered documents.
His permissiveness in Florida surely cost Medicare and Medicaid millions. Less than 2% of medical complaints get any kind of citation at AHCA. Mr. King-Shaw was well aware of the receipt of two sets of different "no match" medical records (an impossibility if they have to be accurate, factual and occur at the time of the happening). He took no action other than to suppress further investigation or action. The age of the patient excused everything.
To hell with the patients, on with profits for his lobbyist friends.
Please. Mr. Thompson, make Medicare work for the patient and taxpayer. Nothing would make me more happy than your avid interest in ending the corruption in this system, which you inherited. Mr. King-Shaw is your appointment. You may not have known about all his dealings in Florida. However, his questionable actions in AHCA are probably of a continuous nature. His actions from now on will reflect on your own integrity, not just his.
Please do not disappoint America. By America, I do not mean corporations, but the hardworking citizens, who deserve better than what they are getting now.
I'll close with a quote from CIRCARE's e-mail FYI dated 6/13/01:
"...Institutions that fail to submit to the cleansing sunlight of disclosure, put a cloud over the entire ...enterprise -- they shake the public trust. Without public trust there will be no public support and we will all be losers in the end."
THANK YOU VERY for you attention. Please forward this proof of fraud and malfeasance, misfeasance and nonfeasance to the appropriate investigative authorities and let's clean up the system. Both taxpayers of all ages and especially the elderly will thank you.
Very sincerely,
Carol Stronstorff,
Founder of the Society for Prevention of Cruelty to Patients, inc.
A necessary Florida corporation
Letter to Secretary Thomspon to review the Medicare Control Authorities in Florida, which affect QUALITY OF care and funding for the elderly Medicare/Medicaid patients
Dear Mr. Secretary:
The Honorable
Secretary of Health and Human Services
Mr. Tommy Thompson
Department of Health and Human Services
330 C Street, SW
Washington, DC 20201