Reads completed on 'less sophisticated' monitors have radiology group refuting claims of billing fraud in court
An Arizona radiology group’s use of “less technologically sophisticated” monitors has a whistleblower questioning the legitimacy of their Medicare claims of services.
On Friday, a court ruled that Eric Stenson, an information technology professional in Arizona, will be allowed to continue with his billing fraud suit against Tucson, Tucson-based Radiology Limited. The decision follows an appeal filed last fall after the court ruled that the case should be dismissed.
In his original suit, Stenson alleged that Radiology Limited violated the False Claims Act by submitting false claims to the Centers for Medicare and Medicaid Services (CMS) due to quality of the monitors their reads were completed on.
Stenson claims that the company wrongfully billed CMS for over $6 million in image reads that did not qualify for Medicare reimbursement due to the subpar computer monitors used to view the studies. Stenson described the Dell monitors, which are not considered medical grade, as “less technologically sophisticated” and, therefore, less effective.
He suggested that “when Radiology Limited conducted diagnostic readings on the Dell Monitors, it was ‘not actually providing the [claimed] services at all.’” Physician testimony and Dell’s own disclaimers corroborate the argument that the monitors in question are not appropriate for use in medical settings unless equipped with specific software (they were not).
“Even if no federal rule, regulation or law requires radiologists to use FDA-approved devices outside of the mammography context, the general Medicare statute nevertheless requires all physicians to provide services that meet minimum efficacy,” the court document states, before noting that Stenson is claiming that Radiology Limited’s interpretations “fall below this federally mandated minimum standard of care.”
Stenson’s argument that the company falsely certified its Medicare compliance by submitting claims for diagnostic reads that didn’t meet a “reasonable and necessary” standard due to the lesser quality monitors they were completed on was upheld by the court. His other claims that were similar in nature, however, were dismissed.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She joined Innovate Healthcare in 2021 and has since put her unique expertise to use in her editorial role with Health Imaging.