An Atlanta-based teleradiology firm has agreed to pay $3.1 million to settle allegations it improperly billed the government for work handled by contractors in India that one physician merely “rubber-stamped.”
The U.S. Attorney’s Office on Thursday announced the settlement with CEO Anand P. Lalaji, MD, and The Radiology Group LLC, which provides nationwide services to hospitals and urgent or primary care providers. A staff radiologist in the U.S. would spend as few as 30 seconds reviewing reports prepared by overseas readers who weren’t permitted to practice medicine nor bill government healthcare programs, authorities charge.
As part of the settlement, The Radiology Group has admitted and accepted responsibilities for the accusations.
“Defendants potentially jeopardized patients’ health by taking shortcuts when it came to ensuring that important radiological tests were done and reviewed properly,” Naomi Gruchacz, Health and Human Services, Office of Inspector General, special agent in charge, said March 28. “Individuals and entities that participate in the federal healthcare system are required to obey the laws meant to preserve the integrity of program funds and the provision of appropriate, quality services to patients.”
In its own statement, The Radiology Group said the “significantly dated” allegations arose from claims submitted to Medicare and Medicaid for services furnished from 2012 to 2018. Two former employees who worked at TRG for a “brief period of time” originally filed the whistleblower complaint under seal. Services at issue were in large part performed by a single radiologist who didn’t follow directions or appropriate protocols and was ultimately terminated. TRG also blamed an unnamed third-party billing company that failed repeatedly to ensure claims were appropriate and payable.
“Unfortunately, The Radiology Group and its executive team trusted these experts in billing as well as their key employee at the time to set up a protocol that was compliant with CMS standards,” TRG said in a statement posted online March 29. “They failed to do so without informing The Radiology group and its leadership team that the process was not occurring appropriately and/or the process of billing was not compliant with standards.”
Since 2019, TRG has spent a “considerable amount of time and resources” to improve hiring, compliance, streamlining workflows and vetting of vendors. Lalaji and colleagues emphasized they believe the company has “acted lawfully and responsibly.”
“However, after nearly six years of investigation, TRG reached this settlement in order to avoid the delay, expense, and uncertainty of protracted litigation, and to allow TRG to focus its attention on providing the best patient care…,” the statement said. “TRG is pleased to move forward from this settlement so it can focus on best serving its clients and patients.”
Lalaji and TRG also misrepresented who rendered the radiology services when seeking payment, government authorities charge. Plus, they improperly sought reimbursement for services furnished entirely by persons outside of the U.S. Nearly $2.7 million of the settlement will be paid to the federal government while the rest will go to various states. As part of the agreement, the company and its CEO have made “extensive factual admissions regarding their conduct.”
U.S. attorneys gave the example of “Radiologist A,” who approved, signed and transmitted to referrers over 100,000 interpretation reports and “frequently approved draft CT scan reports in less than 30 seconds.” TRG allegedly knew it could not submit claims that listed a provider who had not actually rendered the service. But it did so anyway, consistetnly submitting claims listing Lalaji or the other practice owner as the provider, when the work was actually handled in India or the U.K.
“The Radiology Group failed to put in place appropriate safeguards to ensure that their U.S.-licensed radiologists adequately reviewed non-credentialed contractors’ findings before transmitting the reports to physicians who relied on the findings to make patient care decisions,” U.S. Attorney Damian Williams said in the announcement.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.