Challenging Fraudulent medical record created by Blood Diagnostic Center?

Question

Medical Record Fraud
After a routine annual well-care visit to my doctor, and requested blood test, I found two versions of a blood center requisition form -- the one I brought(and kept) to the diagnostic center, and another from the diagnostic center customer service center. My copy only requisitioned basic health and metabolic panel, while the copy provided by the diagnostic center included various other tests not ordered by my doctor. I believe that only a doctor can alter a medical record; and I assume that this requisition form is a medical record. My question is: As the copy provided by the diagnostic center is fraudulent,
in that a medical record was fabricated and/or modified by a non-doctor -- and without his or my permission-- is this a case of medical fraud? More importantly, how do I challenge this medical record fraud? I have received several invoices for the balance of the costs. It runs into the hundreds of dollars.

Answer 1

I think you may be jumping the gun a little.



First of all, a metabolic panel is not actually just one lab test. Its a series of lab tests, hence the word "panel." A basic metabolic panel is actually 8 separate lab tests. A comprehensive metabolic panel is 14 separate lab tests.



Its entirely possible that both of your forms are actually for the same thing, but one just says "metabolic panel" and the other actually has an itemized list of all the components.



There are other valid reasons why the second form could legitimately have more labs on it - your doctor could have given authorization to run additional tests on your blood sample, something in your blood test results could have triggered the need to run an additional test, etc.



Before you start making accusations of fraud, you may want to clarify exactly what the situation is. You'll probably get further with the lab company and your doctor's office if you start off asking a few simple, calm questions.



After getting all the information, if you still determine that there was a discrepancy, I'd suggest contacting your insurance company to start off with. If a lab company had fraudulent practices, the insurer would want to be aware and investigate...it could lead to them canceling the lab company's contract. You could also file a complaint with whatever department/bureau in your state handles licenses for lab providers.

Answer 2

Sometimes additional tests are completed based on the results of the tests that were ordered. For example, a basic choleterol test result that is over a certain number would cause a lipid profile to be done. This also occurs with certain thyroid tests. It may not be fraud if the tests are related. However, it hurts nothing to check. Just report the discrepancy to your insurance company and they will look into it.

Answer 3

~~I would take or or fax the requisition form you know was from your doctor to his office. They will know exactly what they ordered for you. If there is a discrepancy in what you are also being billed for then yes this is very illegal. I would then look under your state's website under consumer help and find a medical complaint department. I would also contact your insurance company who may also be able to assist you. Illegal billing for services is not requested is big trouble for the biller. Just be sure you keep the original requisition in your hands. Good luck!~~

Answer 4

OK, you're assuming that other copy is fraudulent. You need to verify that with your doctor first, to see if they added other tests, and then ask the disgnostic center for an explanation.



There's no "fraud" without a deliberate intent. You need to talk to both of them, before you can assume fraud.

Answer 5

check with your doctor on what they ordered and what was done first, then if it proves to be fraud that they are giving unrequested tests as a means to make more money then get a lawyer and sue their *****'s to the wall.