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$3.1M FCA settlement underscores why official final radiology interpretation reports must be "real"

The United States Attorney's Office for the Southern District of New York has announced this week a $3.1 Million False Claims Act settlement with a teleradiology group and its CEO arising from allegations that radiologists failed to perform legitimate interpretation services and instead relied on reads by radiologists outside of the United States.

The settlement resolves claims that the US-based teleradiology company violated the False Claims Act by fraudulently billing federal health care programs by misrepresenting who actually rendered the radiology services. The government contended that the U.S. teleradiology group improperly sought Medicare reimbursement for services furnished entirely by persons located outside of the United States in violation of applicable statutes and regulations.

As part of the settlement, the teleradiology group admitted that they failed to ensure that their U.S.-based radiologists were conducting a meaningful and adequate review of preliminary interpretations of radiological images prepared by India-based contractors.  The teleradiology group admitted that they regularly submitted claims to federal health care programs where the radiologist who reviewed and interpreted the imaging was someone other than the individual listed on the claim for reimbursement.

According to the settlement agreement, images were transmitted to radiologist contractors located outside the United States, who would conduct initial reviews of the imaging and prepare draft interpretation reports.  After that process was complete, U.S.-based radiologists were supposed to conduct an independent and separate review of the imaging and make all necessary changes to the draft reports before transmitting them as final to the referring physician.  The final interpretation reports were signed by U.S.-based radiologists, who were responsible for the final interpretation reports' contents and whose Medicare identifier numbers were attached to claims for reimbursement from Medicare. The settlement agreement reports that certain radiologists had merely signed off on the draft reports and transmitted them without conducting a meaningful and adequate review of the findings.

At a time of acute radiologist shortages and increasing utilization of radiology services, some radiology groups may be exploring the use of preliminary interpretations from outside the U.S. to increase their efficiency. But they need to make sure their own work is “real.” Official interpreting radiologists must always independently read and interpret radiological images, and independently prepare their own report based on same.

This week's settlement agreement reminds me of a similar FCA settlement agreement entered into in 2020.  The lesson here is to understand that CMS has held a longstanding and uncontradicted view that the interpretation services of a radiologist authoring the official interpretation must be real and not just a “rubber stamp” of a preliminary interpretation. Billing for interpretations that are essentially only "signed off on" by the final reading radiologist could be subject to scrutiny under the theory that that radiologist did not actually fully perform the work as attested to on an applicable claim form.  

The settlement resolves claims that THE RADIOLOGY GROUP and LALAJI violated the False Claims Act by fraudulently billing federal health care programs when the U.S.-based radiologist just “rubber stamped” interpretation reports prepared by contractors in India who were not permitted to practice medicine in the United States or bill federal health care programs.


medicare, federal false claims act, teleradiology, interpretations, health care & life sciences