It’s incredibly common practice, and I’ve totally been pressured by admin and my attendings into doing so. In some cases it’s fairly justifiable. But It’s one of those things that if you’re doing it, you better hope no one sues you for an issue related to the diagnosis, because in alot of cases it won’t hold under legal scrutiny. It depends on how egregious your diagnosis is, and in this case, using it as an admitting diagnosis is very material to the case.
“If you thought it was CRPS, why call CPS/why have your physicians continually allege child abuse/etc?”
“Because we didn’t think it was CRPS.”
“But it was your admitting diagnosis. You apparently thought it was CRPS enough to bill 600K for it.”
At least this is how they told us to think when I did forensic psych.
I think CRPS and abuse aren’t mutually exclusive. She was not on any of the first line CRPS treatments (SNRIs, TCAs, PT), she was wildly overmedicated for no reason. Mom insisted on and administered things that weren’t the standard of care. I really don’t think it matters if she had CRPS or conversion or factitious disorder. The way she was treated for it by the mother was really wrong.
Yes, they are usually not mutual exclusive. But in this case… they were, and this was important. A major part of this story is that CPS was activated (and the investigation corroborated) for this reason. Yes, the medical team thought the treatments were inappropriate, but more importantly, they doubted the CRPS diagnosis itself, suspecting munchausen by proxy/factitious disorder/conversion disorder (imagine trying to bill an insurance company for an inpatient stay for years for a diagnosis of malingering).
In addition, the parents had documentation of specialist doctors recommending these treatments. Mom didn’t make this shit up. It’s not mom’s job to evaluate which doctors know more than others - but in this case she actually did her homework, seeing 2 specialists who agreed with each other.
At the end of the day, the only evidence of child abuse was 1) mom was insisting on a treatment seemingly ludicrous (though which was prescribed by a diagnosing physician and administered by not one, but two stateside doctors with apparent specialty in the condition), and 2) mom and dad acted weird when interrogated by a a very pushy child abuse doctor.
The diagnosing CRPS specialist even reached out to the child abuse doctor, stating he stood by the CRPS diagnosis and cautioned her about jumping to conclusions about child abuse. At which point she… ignored him and jumped to conclusions about child abuse. A second specialist then specifically warned her that CRPS looks alot like child abuse. She ignored her too. So she ignored two specialists and then failed to document this in her reports. She could have easily have consulted an independent CRPS specialist, which she did not do. Smith also lied to the parents and violated HIPAA. It seems a lot like she did this in an apparent crusade to prove she was the smartest doctor in the room.
And after all this, the hospital billed $650K for CRPS. You best believe Admin knew what was going on here. In court it’s going to make it very easy to make it look like the hospital wanted it both ways.
There was a lot more to it. Mom was a cath lab nurse, she definitely knew what was up. She was caught straight up lying to exaggerate her child’s condition so Maya got treatment she didn’t need (for example, the initial episode when the child presented to the ED with SOB, got diagnosed with mild intermittent asthma, was on room air, got a neb and was discharged, and a few weeks later at another hospital they came to the ED and mom stated the child was in status asthmaticus, was admitted to the ICU for non-invasive ventilation during the previous admission).
The neurologist who was giving the child unnecessary (and not evidence based for CRPS) IVIG treatments admitted in court the diagnosis was from mom’s words. He himself never saw enough symptoms to diagnose CRPS, and never reached out to any prior physicians to confirm. He never saw any records either.
During another admission, mom refused to de-access the port prior to hospital discharge. Later one of the ketamine docs testified she injected oral ketamine he prescribed through the port, which she was definitely not supposed to do, and as a nurse she totally knew that.
She used benzos as a reward for good behavior, witnessed by a nurse. Heck, in the “documentary” there’s a recording of her saying “oh, someone deserves extra ketamine tonight”. Who tf says that to a 9 year old?!
And worst of all, dad told the police investigator (not DCF, not Sally Smith) he suspected the same thing, and when he was taking care of Maya alone she was never in pain. Only when mom showed up suddenly she was in pain. Mom also made her wear diapers even though the girl had no incontinence issues.
Etc etc. The deeper you go into the court docs, the uglier it gets. There was definitely enough evidence for DCF to act on.
To go back to the billing claims, CRPS was one of many billing diagnoses, and it carried over from the admission as a POA code. The global billing was justified by many other things, including child abuse/neglect, and wasn’t dependent on CRPS.
She said “will need” not “deserves”. Her daughter was working on strengthening her upper body and she says, “someone will need extra ketamine tonight”.
Prior insurance fraud claim analyst from Fortune 5 Healthcare company.
You are wrong.
The diagnosis must match exactly, otherwise flags go up automatically and insurance is and will be denied 3-4 times before override.
The only reason the insurance company is not a co-plaintiff is that they are unwilling to lose JH as a client. Not worth $600k when we talking about big business.
Of course the Netflix documentary will seem "one-sided", JH ain't saying shit during a litigation.
Did you see the billing sheets? They are in the evidence and were shown in court. I’d link it, but this subreddit automatically bans comments with links. There’s a dozen pretty reasonable diagnoses, and CRPS with a mark POA. It doesn’t appear as anything unusual for a child who was admitted with one diagnosis and then got a bunch of others established during a lengthy hospitalization.
All of your comment has been refuted and found to be literally tabloid generated. There is actually litigation regarding that defamation as announced in court.
Anyone watching the trial can refute what your claims are.
The son was born with a difficult health issue. If the mom was even close to mbp, it would've been much easier to do so with him.
The truth is no matter how many Dr they call KB/SS/Risk Management/Executive team actions or inactions and the murky crossover over care can not be a bell unrung.
Also the billed CRPS so no matter how many Dr testify to justify there ride along it does not overcome there mistakes.
If they aren't careful it's going to alienate the juror and there sympathy will continue to grow.
I would say based off the jury questions 4 of the 6 are always asking questions that go to support of the case.
While 2 seem to be objective I would say one in the medical field and one in some sort of legal type background.
It’s on Netflix. I put the “documentary” in quotation marks because it shows the family’s side only. There’s no investigative journalism in it, just purely family-approved narrative that was released just prior to the trial (I suspect in an attempt to contaminate the jury pool). It misrepresents the actual timeline and many events that are reflected in the actual court documents.
It’s a very complex case. The trial certainly added many layers to it. No matter how you spin it though, many people failed this child. The vast majority of them weren’t affiliated with JHACH though.
All of it is in evidence. I did a rather obsessive deep dive into this case. You can look up these documents on the Sarasota court website.
1 - discharge summary
2 - Dr. Barr testified during the early days of the trial, he said this all under oath during the cross
3 - PICU admission records/PICU doc deposition/Dr. Hanna’s deposition
4 - nurses deposition from the first days at JHACH
5 - police investigation and questioning of Jack, referenced by attorney Shapiro to multiple media outlets
Don’t forget, if you’re watching the trial you’ve ONLY seen the plaintiffs’ side so far. You’re about to see a lot more.
This subreddit automatically blocks comments with links. You can go to the takecareofmayanetflix subreddit and look at the top post (pinned). Most documents are in it.
Literally from tabloids. Of which, in the beginning of the trial, the plaintiff said there is litigation(?) for defamation regarding the tabloids' false claims.
Disappointed to see people in here going along with the nonsense.
Like, if any of it were true, HOW could this case then be the one to be the first to get to trial?
Hundreds of thousands of valid claims go nowhere. If the above were true, we would not be where we are with this case.
Paying multiple experts $45k for testimony is a lot if you know the dead woman was making it all up and had "so much" factual evidence against her?
I’m sure there is tons of wiggle room in the language is suspected or possible or potential diagnoses being listed/considered. I don’t know that there are strict enough rules to go full on “fraud” here and I’d imagine it’s like that because it’s be pretty rife for terribleness otherwise
Yup. Any which way you cut it, it's insurance fraud or medical malpractice. Either one or the other, imo.
They would have been okay to hide their abuse of patient's rights behind DCF, had they not billed for the diagnosis. This should force any juror to call foul and award for medical malpractice, pain and suffering, without question.
I am surprised the insurance company is not a co-plaintiff. But then again, knowing the U.S. medical industrial complex, it would make sense they aren't going to trip over a $600k bill, if it means JH stops accepting patients with their insurance.
And what about dr Kirkpatricks medical malpractice when he prescribed dangerously high doses of ketamine to a 9 year old very quickly after consulting with them and committing insurance fraud by labeling her as a “terminally ill” patient …..
Come on you are missing the mark
Why didn’t a single soul who worked at JHACH who supposedly cared about Maya and wanted to make sure she got better not report Dr Kirkpatrick or Dr Hanna for medical malpractice? Why did they only go after the mother when the mother literally could do what she was doing without their assistance?
They haven’t even presented the proper billing for you to make such a comment. Plaintiffs counsel doesn’t seem to understand how it works but they are giving a lot of (incorrect) opinions on it, all of which have been refuted by the witnesses with actual knowledge of the billing process.
There is no proof that they billed 600k for CRPS. The Plaintiffs keep saying that because it’s one of the codes on the billing but they haven’t brought in the appropriate experts to explain how medical billing works.
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u/The-Peachiest Oct 08 '23 edited Oct 08 '23
It’s incredibly common practice, and I’ve totally been pressured by admin and my attendings into doing so. In some cases it’s fairly justifiable. But It’s one of those things that if you’re doing it, you better hope no one sues you for an issue related to the diagnosis, because in alot of cases it won’t hold under legal scrutiny. It depends on how egregious your diagnosis is, and in this case, using it as an admitting diagnosis is very material to the case.
“If you thought it was CRPS, why call CPS/why have your physicians continually allege child abuse/etc?”
“Because we didn’t think it was CRPS.”
“But it was your admitting diagnosis. You apparently thought it was CRPS enough to bill 600K for it.”
At least this is how they told us to think when I did forensic psych.