Nurse’s Unsupervised Psychiatric Services:
Court Upholds US False Claims Act Lawsuit.
A teenage patient was referred to a mental health clinic for counseling after exhibiting behavioral problems at school.
The girl was eligible for medical care through MassHealth and the clinic participated in that program the state Medicaid agency in Massachusetts.
Her parents complained repeatedly to the lead counselor at the clinic that their daughter was not benefitting from counseling. Twice the lead counselor changed the therapist whom the girl was seeing.
After a time the school gave notice that the girl would not be able to attend classes unless and until she started seeing a psychiatrist.
The clinic’s lead counselor referred the patient to a “Dr.Ortiz”at the clinic. “Dr.Ortiz” was not a physician but was in fact a nurse practitioner.
The nurse practitioner diagnosed the patient with bipolar disorder and prescribed Trileptal,an anticonvulsant used to treat seizure disorders.
When the girl starting having a reaction to the medication her parents tried to call the nurse but their phone calls were not returned.
Because her symptoms were getting worse,and they could not reach the nurse ,the parents decided on their own to have her stop taking the medication.
Abruptly stopping the medication led to a seizure for which the patient had to be hospitalized.
After the parents were able to speak with the nurse practitioner they allowed their daughter to resume treatment with her, still under the impression that the nurse practitioner treating their daughter was a psychiatrist.
Five months later the patient experienced another seizure. That seizure proved fatal.
In the process of filing complaints with various state agencies the parents learned that the facility was not in compliance with a number of state regulations for mental health facilities, compliance being a condition for billing the state’s Medicaid agency for payment.
Parents Can Use US False Claims Act As Basis For Civil Lawsuit
The US Court of appeals for the First Circuit (Massachusetts) ruled that the US False Claims Act is a valid legal vehicle for the parents to pursue a civil lawsuit against the clinic for their daughter’s untimely death.
The parents can sue to recoup not only the Medicaid billings for her care but also for the other clinic patients of the same unsupervised and unlicensed providers going back six years.
The parents can sue the clinic on behalf of the US government to recoup all the clinic’s Medicaid billing for care that was out of compliance with state regulations.
That includes the daughter’s twenty-seven visits and all the patients of the same unsupervised or unlicensed providers going back six years.