Tammy Dickinson, United States Attorney for the Western District of Missouri, announced that the University of Missouri-Columbia has agreed to pay the United States $2.2 million to settle allegations that it violated the False Claims Act by submitting claims for radiology services to federal programs such as Medicare, Medicaid, and TRICARE. The United States alleged that certain attending physicians certified that they had reviewed the images associated with interpretative reports prepared by resident physicians when, in fact, they had not reviewed those images.
“Hospitals and physicians have the highest obligation to both protect patients by complying with the standard of care and to protect taxpayers by complying with the rules for billing federal programs. This lengthy investigation by multiple agencies working together has produced a just result for both patients and taxpayers,” said United States Attorney Dickinson.
Steve Hanson, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General, Kansas City Regional Office, stated, “Our office will continue to work with our law enforcement partners to ensure that qualified medical professionals are reviewing radiology exams such x-rays, MRIs, CT scans, ultrasounds, etc., to accurately diagnose our beneficiaries’ medical conditions.”
“The Defense Criminal Investigative Service is committed to working with our partner agencies to combat fraud impacting the Department of Defense’s vital programs, operations and resources. The victims of this kind of fraud are real people and it impacts those who have served our country the most,” said Brian J. Reihms, Special Agent in Charge, Defense Criminal Investigative Service (DCIS).
A federal investigation commenced in 2011 and led to an internal investigation by the university. The university determined that two attending radiologists, Dr. Kenneth Rall and Dr. Michael Richards, violated Medicare and hospital rules when they certified certain interpretive reports prepared by resident physicians. Medicare will pay claims for resident physicians to interpret radiological images but only if an attending radiologist also reviews the image and provides any necessary input to the interpretive report. Rall and Richards left the employment of the university in June 2012. The university cooperated throughout the lengthy investigation. In addition to this False Claims Act settlement, the university also entered into a Corporate Integrity Agreement with HHS-OIG.
The case, United States ex rel. Galuten v. University of Missouri-Columbia, et al., Case No. 11-cv-04140-FJG (W.D. Mo.), was handled by the U.S. Attorney’s Office for the Western District of Missouri, HHS-OIG, and DCIS. The claims settled by this agreement are allegations only, and there has been no determination of liability.
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