An Atlanta-based national radiology practice has agreed to pay $3.1 million to settle a federal lawsuit accusing it of outsourcing medical imaging work to contractors in India and then rubber-stamping their findings. But the settlement has not resolved the troubling questions about whether patients received misdiagnoses as a result.
In announcing the settlement, the Department of Justice said that health care providers throughout the U.S. relied on reports submitted by The Radiology Group, but the company failed to conduct meaningful reviews of reports performed by non-licensed workers in India. One company radiologist, who issued more than 100,000 reports, frequently approved, signed and transmitted interpretation reports of CT scans in less than 30 seconds. Aside from the writeup, CT scans may have from fifty to more than 1,000 images to review, a series of pictures much like the cells in a cartoon film reel.
“Defendants potentially jeopardized patients’ health by taking shortcuts when it came to ensuring that important radiological tests were done and reviewed properly,” the U.S. Attorney’s Office for the Southern District of New York said in announcing the settlement.
The company and its CEO, Dr. Anand Lalaji, must pay the federal government $2.7 million. The federal claims involve bilking federal health care programs by billing for services that didn’t meet federal standards. They must also pay about $400,000 to states that had separate claims against the company.
The suit began as a complaint by two whistleblowers. No information is available about the number of patients potentially affected. But the company’s clients include hospitals, clinics and medical practices in many states.
In comments to The Atlanta Journal-Constitution and a statement posted on its website, the company and Lalaji said the violations were from 2012 to 2018, and blamed them on a rogue employee who wouldn’t follow direction and was eventually fired. But the government suggested that the company should have known the reports were getting approved too fast.
A company and its CEO
The Radiology Group, based on Peachtree Road, is licensed in more than 40 states. The company’s founding visionary was Dr. Anand Lalaji, the CEO. The group touts that it “streamlines communication, increasing our speed — and customer happiness.” It also says they prioritize accuracy. The company’s website advertises average speeds for four types of reviews: at the low end, 8.43 minute turnaround times for evaluating images of a hospital stroke patient, and at the high end, 24.35 minute turnarounds for interpreting an ER CT scan.
Credit: Hart, Ariel (AJC-Atlanta)
Credit: Hart, Ariel (AJC-Atlanta)
Lalaji is a radiologist licensed to practice in approximately 20 states, according to the Federation of State Medical Boards. In responses to the AJC, he said he has 19 years of experience. But questions have been raised in at least one state about him misinterpreting scans himself, and his response in dealing with the problem.
The Kentucky Board of Medicine in November reported that Lalaji had misread several images at a hospital in that state in 2022, including missing a brain tumor. Even after the hospital worked with Lalaji to resolve the problems, concern for patient safety remained, it said.
Then, in responding to the Kentucky board’s review, Lalaji led the board’s expert to wonder whether Lalaji was “taking the issue seriously,” he said. The expert added, “Frankly, I find the lack of a coherent or complete response disturbing.” Kentucky issued an emergency suspension of his license. Lalaji told the AJC the board proceeded unfairly and a follow-up hearing is scheduled.
The federal settlement also cites The Radiology Group for listing Lalaji as writing reports that he didn’t do, but were actually done by a different radiologist living in the United Kingdom. Medicare doesn’t pay for services that were rendered outside the United States. Lalaji was listed on the reports instead, and the group billed Medicare.
Lalaji and the company say they relied on bad advice from a billing company about what was legal. As to the Kentucky board allegations, Lalaji said, they “have nothing to do with this settlement.” They relate to one short-staffed hospital in Paducah, he said, and he strongly disagrees with their findings. He is preparing for a follow-up hearing in May with his own experts. “The [Kentucky] issue will be resolved shortly,” he said.
Patients
The settlement agreement does not direct the fine money to patients who may have been harmed, nor does it say whether it identified any specific patients who were harmed.
If patients want to find out when there are concerns about their care providers, it’s not easy. Regulatory bodies tend to keep allegations secret while they build a case file and look for patterns. They tend to be slow.
The Radiology Group is accredited by the Joint Commission, an organization that evaluates hospitals and other health facilities nationwide. Anyone who looks up The Radiology Group on the Commission’s website will simply see that the group has addressed nationwide issues, and is accredited with the Joint Commission’s standard “Gold Seal of Approval.”
Asked about the settlement and Lalaji’s individual license issues, a spokeswoman for the Joint Commission, Maureen Lyons, declined to comment. “Because accreditation with The Joint Commission is voluntary, some information remains confidential,” she said.
The American College of Radiology, a doctors’ group that issues guidelines for appropriate radiology practices, also declined to comment on what rules The Radiology Group broke or didn’t break. In general, the College says use of foreign contractors can be appropriate under certain circumstances. But they say the person interpreting the examination and submitting the report must be one and the same.
The AJC asked The Radiology Group whether it was continuing to outsource scans to people in India or people in other countries, and if so whether they were qualified.
Lalaji responded: “All TRG scans are officially interpreted within the territorial United States by United States board-certified radiologists.”
PATIENTS’ RIGHTS TO KNOW
Medical care is increasingly provided by independent contractors, rather than one hospital or practice that employs every worker in the supply chain. For patients who want to understand who’s responsible for their care, here are some tips.
- Patients have the right to the information contained in their medical records, according to federal law.
- That should include the records showing which doctor performed what service, said Lyle Warshauer, an Atlanta attorney who has represented patients in lawsuits over radiology reports.
- If the patient wants to track that down, they can start by asking their primary doctor.
- In providing a copy of a medical record, the health practice is allowed to charge a reasonable fee, for its copying costs.
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