Case Accomplishments

Rose Clifford, RN, LNCC Senior Nurse Consultant

Case Accomplishments Personal Injury Case - Involved an overhead bin popping open upon landing of the aircraft where luggage weighing approximately 50 pounds fell on top of a passenger's head causing the ligament between C1 and C2 to tear requiring two cervical fusions. Resulted in a $1 million settlement in 1988.  Medical Malpractice OB Case…Pre-eclampsia - Failure of the nurses to notify the doctor of change in patient status resulting in severe brain damage to the mother and baby. Settled for more than $7 million in 1991. Medicare Fraud Investigation - Reviewed and micro-managed a large volume of records for off-site reviews of home health agencies and physician offices for medical necessity, billing accuracy and appropriateness of care. Project included identifying fraudulent issues and Medicare overpayment. Review findings resulted in potential criminal charges against the home health agency. Total recovery was $3 million returned to the Federal Trust Fund - Medicare Part A in 1997. Due Diligence Investigation: Team coordination and project management for due diligence with major accounting firm for a national health care corporation pre-purchase of two states' regional chain of twelve skilled nursing homes. The investigation included on-site visits, staff interviews, review of payor billings, review of medical records, policies and procedures. Resulted in $15 million savings in purchase price in 1998. Insurance Subrogation Claim - Review of Medical Records and line item billing for the determination of medical necessity, causation, preexisting, reasonableness and appropriateness of medical treatment and billing procedures for the detection of health care provider fraud, fraud by the insured in a personal injury protection auto insurance subrogation claim. Case resulted in a $40,000 savings.  Criminal Case of a child abuse and murder that lead to the incarceration of the mother in 2000. Medical Malpractice Case against a university hospital where a five-month-old underwent a cardiac cath and angioplasty. The hospital and cardiologist failed to timely replace the blood loss, leading to a cardiac arrest causing severe brain damage. Settled for an undisclosed amount of more than $12 million in 2005.