Presented by Hodgson Russ, the Whistleblower Blog is written by a team of lawyers experienced in successfully guiding both whistleblowers and companies accused by whistleblowers of wrongdoing through the False Claims Act process.

Teleradiology Ghost Reading Present False Claims Act Issues

Leaving aside licensing and qualifications issues, one larger issue remains: will Medicare pay for this? And are claims submitted to Medicare for radiology services provided overseas legitimate? The answer seems to be no. Services provided outside the United States are generally not reimbursable by Medicare. In fact, a Center for Medicare & Medicaid Services (CMS) manual uses a teleradiologist based in India as an example, saying Medicare will not pay for reads done by that radiologist.

One potential end-run around this prohibition involves “ghost reading,” where an overseas radiologist actually reads the images (and is paid far less for it than a U.S.-based radiologist would be), yet a U.S.-based radiologist signs off on the read. This practice, which involves no real readings or interpretations by the U.S. doctor, is fraught with potential problems, including the potential for a False Claims Act violation for submitting false claims to Medicare. The literature, including articles from the American College of Radiology, remains unclear about the prevalence of this slippery practice.

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