Experts are sharing a potential “wake-up call” for those who use radiology residents to read medical images.

Robert Optican, MD, and Richard Duszak, MD, detailed their concerns in an analysis published via Current Problems in Diagnostic Radiology [1]. They highlighted a fictionalized true story of a busy academic medical center in a bustling U.S. metro area, which sponsors a 60-person radiology residency program in its well-regarded imaging department.

During overnight hours, residents review exams and dictate preliminary “wet reads” to help ED docs to make timely decisions. The next morning, two attending senior radiologists “batch sign” resident reports, allowing them to get a jump on their work lists. Residents can raise concerns about any tough cases, but rarely ever do.

“For these attendings, this has been standard practice for at least 10 years and has never been challenged by the department chair or department administrator,” wrote Optican and Duszak, with the departments of radiology at Duke University and the University of Mississippi Medical Center, respectively.

A second-year radiology resident becomes uncomfortable with this morning sign-out process and relays the details to his sister-in-law, a local attorney. The individual eventually files a whistleblower lawsuit under the False Claims Act, leading to a $7 million settlement with the government and $900,000 award to the resident for raising the concern.

Such “qui tam” lawsuits are common in the U.S., the writers noted, with their volume increasing by 600% in the decade leading up to 2022. About two-thirds of filings are healthcare-related, producing an average reward of over $500,000 per each newly referred case.

“This case highlights why academic radiology departments should proactively educate their faculty, trainees, and staff regarding the False Claims Act and other relevant laws and regulations,” Optican and Duszak advised. “Departments should also self-audit and take raised concerns seriously.”

Their example mirrors a similar FCA case (albeit with a much smaller payout) against University of Iowa Health Care. The U.S. Attorney’s Office accused the Iowa City institution of perpetrating a “batch signing scheme” in which it billed for services rendered by residents during on-call shifts. Rather than complete the necessary review, the office alleged, physicians instead would engage in “rapid-fire signing of dozens of reports within a matter of a minute or so, solely in order to falsely bill the government for ‘interpretations’ that never took place,” the complaint alleged.

The University of Iowa ended up paying $16,444, along with implementing mandatory physician training, to settle the case. UI cooperated fully and did not admit to any wrongdoing as part of the settlement.

Read more from the two writers at the link below.