In recent years we have encountered many stand alone radiology centers and clinics. Often these facilities are not connected with a healthcare group or hospital. Some are not even owned by a doctor. The proliferation of these centers has caused cutthroat competition in many areas of the country. Sometimes when a healthcare company can’t make money there is a temptation to cut corners and engage in illegal activity.
This post will look at a recent case and discuss how awards may be available for those who report these schemes. Often the person reporting fraud is an honest competitor simply trying to remain in business. We find that when radiology centers cut corners, both patients and honest radiologists lose.
Rose Radiology Centers
Earlier this year, the U.S. Attorney in Tampa, Florida successfully prosecuted Rose Radiology Centers for violating the federal False Claims Act. Prosecutors say that Rose billed for medically unnecessary services. The company was also accused of not having a physician present for certain procedures. Federal regulations requires a doctor to be actively supervising and on the premises certain types of procedures.
There were actually two cases filed against Rose Radiology Centers, both filed by whistleblowers. In the one case, a licensed radiology technician, Carlene Schimke, reported that the center was performing dye contrast scans without physician supervision. She also said the center was sometimes performing services without a prescription.
Dye Contrast Studies
Dye contrast studies involve injecting a patient with a special type of dye. The dye helps radiologists better view images. Because there is a risk of a severe allergic reaction, Medicare says that a doctor must be physically present when the dye is injected. (The regulations say that the physician “must be present in the office suite and immediately available.”) In some instances the reaction can be fatal if not treated immediately.
Health and Human Services regulations say that the physician supervising must be qualified to perform the tests that are being administered. Finding a retired doctor who never administered dye or worked as a radiology to simply sit in an office and read the newspapers is also prohibited.
The other case was filed by Katrina Miller, a billing specialist employed by Rose. She claimed the center was billing for services not medically necessary and not authorized by the patient’s doctor. She also says the center paid kickbacks in the form of preferred provider discounts, forged prescriptions and operated several locations that were not licensed by Medicare.
Rose Radiology Centers Settlement
Rose ultimately settled both cases for a combined $8.71 million. The two women who brought the claims split a whistleblower award of $1.7 million.
In announcing the settlement, a Health and Human Services spokesperson said in a prepared statement, “It is unconscionable for a physician to allow someone without the proper medical training to administer a test that could cause serious harm. Not only do the kinds of frauds that were alleged in this case rob Medicare of needed funds, they threatened the health of elderly and disabled Americans.”
University of Missouri Settlement
In July of this year, the University of Missouri settled charges with the Justice Department over charges that two of their radiologists were billing Medicare for reviewing images even though they had not done so. Instead of personally reviewing the images, the two doctors allegedly let residents of the medical school do so.
That case was also filed by a whistleblower, this time a faculty member in the school’s radiology program.
One of the doctors involved in the scheme pled guilty to criminal charges. He also surrendered his license to practice medicine. Both doctors lost their jobs at the university.
Special Rules for Independent Diagnostic Testing Facilities (IDTF)
The University of Missouri radiology department isn’t an independent diagnostic testing facility or IDTF. We shared the story, however, since we often see cases in which specialized physicians are being paid to review x rays or images but are instead sending them offshore where quality control is hard to measure. The UM story is unique in that students were apparently reading the images.
Standalone radiology centers such as Rose Radiology operate with very strict rules. Included in those rules are restrictions on performing tests without the specific request of the patient’s treating doctor, billing Medicare for tests ordered by chiropractors, and having unlicensed facilities. Medicare and state regulators can’t inspect a facility if they don’t even know it exists.
There are also special rules for advertising including a ban on direct solicitations of patients. (Offering kickbacks disguised as gift baskets, gas cards and the like are also prohibited.)
Most radiologists do a great job and provide an extremely valuable service. Ditto for many of the independent radiology centers that seem to be springing up everywhere. Unfortunately, as competition gets fierce and some centers struggle to make payments on multimillion dollar machines, we also see fraud.
False Claims Act and Whistleblower Awards
The federal False Claims Act was passed in 1863 during the Civil War. Still on the books today, the law allows whistleblowers to earn cash awards for their information. To qualify, you must have inside information about fraud involving a federal program or funds. Awards are based on the amount recovered by the government.
Only the first person to report usually gets the award so don’t wait. In the Rose Radiology Centers case, two whistleblowers received awards because each had different information.
To see if you qualify, call us. The call is free and all inquiries are protected by the attorney – client privilege. You can also visit our Medicare fraud or false documentation whistleblower claims information pages. To speak with a whistleblower lawyer immediately, contact attorney Brian Mahany at or by telephone at (direct).