oversight

Department of Veterans Affairs | Beckley, WV | 18-26 | Unknown

Published by the Office of Special Counsel on 2018-06-27.

Below is a raw (and likely hideous) rendition of the original report. (PDF)

The First VERA Analyzer Audit for FY16Q1 there was 85 potentials for increase
hierarchy funds, and I audited them I found 23 totaling $409,803.00 in VERA
funds. HIM inpatient coder only changed 4 or 5 of them.               and I sent
e-mails to Chief HIM, Chief HAS, Coding Supervisor and they said they were
working on something else. Codes never changed.



9/18/15 – Compliance and Business Integrity Officer (CBI)

              , CBI Officer, came to my office at the “Lease Space” and sat with me
while I explained the coding errors for TBI and all the rest of incorrect coding I had
found. I know he understood what I was saying, but he continued to report 100%
accuracy on the inpatient, because he did not want to go against        ,      ,
     , or     .
7/23/15 – 10 Traumatic Brain Injury (TBI) Veterans records

I had corrected 10 veteran TBI charts that were coded incorrectly, trying to help
out, since no one in the hospital knew the TBI Special Guidance Criteria except
me. I added correct E Codes and symptom codes, and deleted late effect codes
per “TBI Special Guidance” 2015. I told     I had corrected them and she had
another coder to go in and change the codes back to incorrect. VERA – loss
$127,698..00. Not to mention that the physician had dictated TBI and it needs to
be coded correctly to be captured by our OIF, OEF, OND clinic, which I had fought
to get set up correctly. And for the veteran to receive services for a service
connected injury. TBI’s/ PTSD/Depression are all connected to the Suicide rate of
appx 22 veterans a day, nationwide. and should be coded when diagnosed.

September 26, 2014 – Metastatic Cancer

 I noticed an inpatient chart had been coded absolutely wrong. I queried the
provider and he agreed with me that the skin cancer metastasized and had
tunneled into the veterans lymph nodes under his arm creating a huge
nonhealing infected ulcer. I opened the Medical Record and changed the codes
to
the correct ones. I then sent an e-mail to   ,   and   (the