The DOJ recently announced that The Radiology Group (“TRG”), a teleradiology provider that performed radiology services (e.g., reading and preparing interpretation reports for MRI scans, CT scans, etc.) for other healthcare providers like hospitals and primary care doctors, and its CEO/co-owner will pay over $3 million to settle a False Claims Act case.

The primary allegations in the DOJ’s complaint were that the defendants submitted or caused the submission of false claims for services that “(1) were not furnished by a U.S.-based credentialed radiologist because TRG’s radiologist just ‘rubber stamped’ radiology interpretations that were performed by persons located in India who were not U.S.-licensed physicians or providers enrolled in any Federal health care program; (2) were not rendered by the radiologist listed by TRG as the rendering provider in the claim for reimbursement; and/or (3) were furnished entirely by persons located outside of the United States and were thus ineligible for reimbursement from Medicare.”

The DOJ’s complaint provides some jarring examples in support of each of these overarching allegations:

A radiologist “approved, signed, and transmitted to Healthcare Providers over 100,000 Interpretation Reports during the Relevant Period.” ¶ 40.
“[A] hospital emergency room requested that TRG interpret a CT scan of a patient’s abdomen. A TRG contractor in India prepared a draft Interpretation Report for this CT scan, and [a radiologist] approved the draft report in less than 16 seconds.  It was not possible for [the radiologist] to have reviewed all of the images associated with the CT scan and properly considered whether any changes should have been made to the Interpretation Report in fewer than 16 seconds.”  ¶ 41.
Defendants “began to internally track the amount of time radiologists spent reviewing the draft Interpretation Reports,” and they “identified [a radiologist’s] turn-around times as ‘notably short,’ particularly with respect to MRI and CT studies.” ¶ 42.
“TRG’s billing company emailed a chart to [the CEO] and others that listed twelve TRG radiologists as the actual rendering providers, but showed that the services would all be billed to Medicare and Medicaid under the names and NPIs of [the CEO] and the other owner of the practice. Although TRG internal reports showed that [the CEO] and the other owner of the practice rendered less than 10% of the total diagnostic radiology services billed by TRG, Defendants listed them as the rendering provider on over 80% of the claims submitted to Medicare Part B [from April 1, 2013, to July 31, 2019].”  ¶¶ 47-48.
“Defendants submitted claims for payment for diagnostic radiology services provided by a TRG radiologist who resided and worked in the United Kingdom …. Many of these claims for payment falsely listed [the CEO] as the rendering provider.  …  [The CEO] received an email noting that [this radiologist] had only been in the United States for a total of two weeks in the past seven years and had little desire to ever go back to the United States.”  ¶¶ 52-53.

This case is another example of a successful False Claims Act lawsuit originally brought by whistleblowers.  In this case, there were two whistleblowers who raised concerns about the conduct at issue: (1) TRG’s former Director of Operations, and (2) a radiologist who was an independent contractor for TRG.  Many times, a company’s employees and independent contractors are in the best position to bring misconduct to light because in the ordinary course of their work they gain an inside perspective on certain business practices of a company that may violate the law.

If you would like more information on what it means to be a whistleblower or think you may have information relating to healthcare or pharmaceutical fraud, fraud by radiology practices or other healthcare providers, fraud involving kickbacks, or any other kind of fraud or misconduct involving a government program, please feel free to contact us so we can connect you with a member of the Constantine Cannon whistleblower lawyer team for a free and confidential consultation.

Read Radiology Practice, CEO Settle False Claims Act Case for $3.1 Million at constantinecannon.com