Independent Diagnostic Testing Facilities (IDTF) such as Store Front MRI Clinics Are often Hotbeds of Medicare Fraud. If You Have Inside Information about Fraud, You May Be Eligible for a Cash Reward
If you are reading this post, you are probably a healthcare professional and already know that an IDTF is an Independent Diagnostic Testing Facility. These facilities can be a store front (fixed location), mobile unit or an individual non-physician practitioner that provides diagnostic tests independent of a physician’s office or hospital.
Many of the store front radiology clinics in America are IDTFs. The public thinks that these X-Ray and MRI operations are owned by a physician but there is absolutely no requirement to do so.
To get reimbursed under Medicare, the law requires that the facility must have a supervising doctor. To make sure that the supervising doctor isn’t spread too thin, Medicare doesn’t allow a doctor to supervise more than three sites.
Because these facilities are not owned by a physician, any films or images from the IDTF must be reviewed by a radiologist. And that’s where some IDTF owners cut corners.
Buying an MRI machine (called a “magnet”) can cost $1 million. X-Ray machines aren’t cheap either. The payments on these machines can be so high that some operators cut corners by outsourcing the reading of the images to doctors outside the United States.
When a facility outsources the reading or interpretation of diagnostic tests it is called an outside read. Often these outside reads are done by doctors are in India.
Chapter 16 of the Medicare Claims Processing manual makes clear that Medicare won’t pay for services rendered outside the United States. It’s not that Indian – or foreign doctors in general – are substandard. The opposite is true. Instead Uncle Sam believes it has better control of quality and can maintain better accountability by mandating services be performed here.
In fact, the Medicare manual says,
“if a radiologist who practices in India analyzes imaging tests that were performed on a beneficiary in the United States, Medicare would not pay the radiologist or the U.S. facility that performed the imaging test for any of the services that were performed by the radiologist in India.”
Despite clear standards, we still hear of IDTFs outsourcing their work to India.
If the quality is just as good as here as in India, why would these private imaging facilities send their X-Rays all the way to India?
First, images can be read in real time anywhere in the world. Sending an MRI image to India is just as easy and quick as sending an issue across town. It is all done electronically.
The big reason, however, is money. Radiologists in India are typically paid a fraction of what a radiologist in the U.S. is paid.
It’s Not Just Radiologists – U.S. v. LifeWatch Services
In 2015, a federal magistrate judge in Illinois allowed a False Claims Act whistleblower case against LifeWatch Services to proceed. LifeWatch is an IDTF that performs remote heart monitoring services. You can be wearing a Holter monitor in Cleveland while a technician anywhere in the world monitors your heart.
A whistleblower claimed LifeWatch “uses technicians in India to perform a substantial number of remote cardiac monitoring tests, including some for patients covered by the Government Insurers [Medicare, Medicaid and Tricare]. As we know, all services must be performed in the United States. If the monitoring was done by someone in India, LifeWatch allegedly changed the name on the report to a U.S. technician.
The case ultimately settled. It is interesting to note that LifeWatch previously agreed to pay the feds $18.5 million in 2012. In the earlier whistleblower case, LifeWatch improperly billed Medicare for ambulatory cardiac telemetry (ACT) services. That case did not involve the use of offshore technicians. Two former sales reps for the company, Ryan Sims and Sara Collins split a whistleblower reward of $3.4 million in that case.
False Claims Act Pays Cash Rewards to IDTF Whistleblowers
The federal False Claims Act pay cash rewards to whistleblowers with inside information about healthcare fraud involving federal funds. That means Medicare, Medicaid and Tricare.
If you are the first to file you may be eligible for a cash reward of between 15% and 30% of whatever the government t recovers from the wrongdoers. And powerful anti-retaliation provisions offer protection if you are still employed by the wrongdoer.
Being the first to file doesn’t mean the first to call a government hotline. To qualify for the reward, you need to file a sealed complaint in federal court. And that is where we come in.
As one of America’s leading whistleblower firms, we can handle everything from the investigation to filing of the complaint and even prosecuting the case for the government if the Justice Department declines prosecution.
Other IDTF Medicare Fraud Schemes
This post concentrates on IDTF scams involving outside reads by offshore radiologists and other diagnostic services performed outside the United States. Unfortunately, we have seen a great number of other IDTF Medicare fraud scams. These include performing medically unnecessary services and performing contrasting dye services without a physician present. We have also seen various scams involving illegal kickbacks.
IDTFs have very severe advertising restrictions. “$99 MRI walk-in specials” and giving gift baskets to patients who refer other patients are often viewed as illegal kickbacks.
To learn more about Medicare Fraud involving Independent Diagnostic Testing Facilities, visit our IDTF and Radiology Whistleblower post.
Ready to see if you have a case? Contact us online, by email brian@mahanylaw.com or by phone at 202-800-9791. We handle cases anywhere in the United States.
Wondering how we get paid? As whistleblower lawyers, we operate on a contingency fee basis meaning we only get paid if we win and collect.
Worried about someone finding out about your whistleblower case?? Cases are filed under seal meaning in secret. Ultimately the court unseals the complaint, however, usually that takes at least a year. We are happy to discuss all the details and answer your questions. All inquiries are protected by the attorney – client privilege and kept confidential.
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