Teleradiology Group Settles for $3.1 Million For Violating False Claims Act

01 Apr, 2024 F.J. Thomas

                               

Sarasota, FL (WorkersCompensation.com) – While still subject to specific regulations, telemedicine has revolutionized healthcare in many ways. Not only has telemedicine provided a way for quick, convenient healthcare, it has improved healthcare access overall. 

As part of telemedicine, teleradiology is when images such as x-rays or MRIs are sent electronically over the internet for interpretation to a radiologist who potentially could be located and licensed anywhere in the world. The Interstate Medical Licensure Compact, which covers 39 states, makes it possible for radiologists to interpret images from other states. 

Federal payers considers the site of service to be where the physician interpreted the image. According to criteria of the American College Of Radiology, in order to appropriately bill for teleradiology, the person interpreting the examination and submitting the report to a referring provider must be the same person. Additionally, that person providing the report must be licensed and credentialed as a member of the staff at the institution performing the examination and receiving the report, and must be directly available for consultation. 

These same rules would apply in cases where images are transmitted and interpreted outside of the U.S. In a recent settlement announced by the U.S. Attorney’s Office, a teleradiology group based in Atlanta, Georgia has settled for $3.1 million to resolve allegations of violating these requirements. 

The Radiology Group (TRG), created by Dr. Anand Lalaji, specializes in quickly providing diagnostic radiology services on a unique platform to all levels of care across the country, including physicians, urgent care centers, and hospitals. Radiologist owned, according to their website the group hand picks all of its radiologists. 

According to the complaint filed in a Manhattan federal court earlier this month, TRG received images for review, and then sent the images to contractors which were outside of the U.S. The offshore contractors would then perform an initial review of the imaging and then prepare a draft interpretation report. After the initial review, a U.S. based TRG radiologist was supposed to conduct a separate review of the imaging and make any necessary changes to the reports before they were transmitted back to the referring provider.  

Federal investigators allege that from April 2013 through July 2019, TRG billed federal programs for radiology services in which the TRG radiologist “rubber stamped” the radiology interpretations that had actually been done by contractors in India that were not licensed in the U.S. No actual in depth  review was performed by the TRG radiologist. In doing so, claims were filed to federal payers under U.S. licensed radiologists when in fact the actual rendering provider was outside of the U.S. and not qualified. 

The qui tam lawsuit was initiated by a former Director Of Operations, Allison Lynes, and former contracted radiologist Jeffrey Zuckerman, M.D. As part of the settlement, TRG has admitted and accepted responsibility for the allegations included in the complaint. 


  • arising out of arizona california case management case management focus claims cms compensability compliance courts covid do you know the rule exclusive remedy florida FMLA fraud glossary check health care Healthcare iowa leadership medical medicare minnesota NCCI new jersey new york ohio opioids osha pennsylvania Safety state info texas violence virginia WDYT west virginia what do you think women's history month workers' comp 101 workers' recovery workers' compensation contact information Workplace Safety Workplace Violence


  • Read Also

    About The Author

    • F.J. Thomas

      F.J. Thomas has worked in healthcare business for more than fifteen years in Tennessee. Her experience as a contract appeals analyst has given her an intimate grasp of the inner workings of both the provider and insurance world. Knowing first hand that the industry is constantly changing, she strives to find resources and information you can use.

    Read More

    Request a Demo

    To request a free demo of one of our products, please fill in this form. Our sales team will get back to you shortly.