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Teleradiology company and CEO admit to unlawful billing, will pay $3.1 million

por John R. Fischer, Senior Reporter | April 02, 2024
Health IT Telemedicine
The Radiology Group and its CEO will pay $3.1 million for falsely billing federal healthcare programs and misrepresenting radiologists in claims.
A teleradiology company and its CEO have been ordered to pay $3.1 million as part of a settlement for misleading and fraudulently billing federal healthcare programs by submitting claims for services performed by non-U.S.-based radiologists who are not certified to practice medicine in the country.

The Radiology Group is based in Atlanta and interprets scans for hospitals, urgent care centers, and primary care physicians nationwide. As part of its operational model, the company has contractors in India who review the scans, which are then supposed to be reviewed and approved by its U.S. radiologists.

But according to a lawsuit filed against it, certain American radiologists merely “rubber stamped” reports without adequately reviewing them, a fact that both The Radiology Group and its CEO Anand Lalaji admitted they were aware of but did nothing to stop. Moreover, despite being prohibited by federal healthcare program rules, when the company submitted reimbursement claims for the services, it misrepresented its radiologists as having reviewed and interpreted the scans when they had not.

One radiologist went as far as to approve, sign, and bill for over 100,000 reports and images that he did not assess, and frequently approved draft CT scan reports in less than 30 seconds, according to the suit.

“Defendants potentially jeopardized patients’ health by taking shortcuts when it came to ensuring that important radiological tests were done and reviewed properly,” said Office of Inspector General, U.S. Department of Health and Human Services special agent in charge Naomi Gruchacz in a statement.

In addition to the Indian contractors, The Radiology Group also employed and relied on a radiologist in the U.K. to review diagnostic radiology scans that it billed to Medicare, despite not being legally allowed to do so for reports interpreted by this physician as well.

The company and Lalaji admitted their failure to put in place safeguards to ensure U.S.-based radiologists correctly reviewed the work of non-credentialed contractors and for sending these unreviewed reports on numerous occasions to primary care physicians who required them to make care decisions for their patients.

In connection with the suit and settlement, the government joined a private whistleblower suit filed under seal pursuant to the False Claims Act.

Of the total sum, $2,678,387.21 will go to the U.S., while the rest will go to various states.

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