The DOJ announced that Atlanta based teleradiology company, The Radiology Group, and its CEO Anand Lalaji, ( collectively “TRG”) have entered into an agreement with the United States to settle allegations of violating the False Claims Act (FCA). As part of the settlement agreement, TRG has agreed to pay $3.1 million to resolve allegations of submitting false claims to federal health care programs for radiology services conducted by contractors outside of the United States.
TRG provides diagnostic radiology services to referring providers at various hospitals, urgent care centers, and primary care physician offices across the country. Referring providers routinely transmitted imaging to TRG for review and interpretation reports. According to the complaint, from April 1, 2013 to July 2019, TRG sent images they received to contractors outside of the United States for initial review and to prepare the required interpretation reports. In turn, TRG’s U.S. based radiologist were supposed to conduct an independent review of the contractors’ findings and reports and make all necessary changes before transmitting to a referring physician. However, TRG radiologists allegedly spent less than 30 seconds to review the contractors’ reports and just “rubber stamped” their findings. As such, the government alleged that TRG knowingly submitted false claims for radiology services that were not rendered by U.S. based and credentialed radiologists to Medicare, Medicaid, TRICARE, and Veterans Health Administration Programs. TRG also listed their U.S. based radiologists as the rendering provider when they submitted claims for reimbursement.
TRG admitted and accepted responsibility for, among other things, approving interpretation reports prepared by non-licensed individuals in India without conducting meaningful reviews and submitting claims to federal health care programs where the provider listed on the claim was not who reviewed and interpreted the images. TRG also admitted to submitting claims for reimbursement performed by one of their United Kingdom based radiologists.
This matter was initially filed by Allison Lynes, who was employed as TRG’s Director of Operations from approximately 2014 to 2018.under the qui tam provisions of the FCA. TRG will pay $2,678,387.21 to the United States and the remaining to various states. When the settlement was announced, U.S. Attorney Damian Williams commented that “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. This Office is committed to holding healthcare providers accountable when they violate clear rules and regulations designed to ensure the integrity of taxpayer funded healthcare programs and protect patient quality of care.”
The attorneys at Chilivis Grubman represent clients of all types and sizes in connection to False Claims Act investigations and litigation. If you need assistance with such a matter, please contact us today.