An audit of after-hours payments for publicly funded teleradiology reads in Canada has found that radiologists were paid higher premiums without meeting all the criteria outlined in their agreements, according to a July report out of the province of Prince Edward Island.
Total fees paid to radiologists have increased by approximately 4 million Canadian dollars ($2.94 million U.S.) in the past five years, noted the independent assurance report prepared by the Office of the Auditor General of Prince Edward Island (PEI), including over 450,000 Canadian dollars ($330,000 U.S.) in after-hours premiums to radiologists outside of the province in fiscal 2024 alone.
After examining a sampling of 30 after-hours premiums paid by the province's Medicare system, Health PEI, auditors found that 47% of claims did not qualify for the higher premiums due mostly to timeline issues.
In September 2021, Health PEI entered into a teleradiology agreement with an unnamed third-party company to provide diagnostic radiology services to Prince Edward Island hospitals. The agreement was for teleradiologists to provide diagnostic services from 6 p.m. to 8 a.m. Monday through Friday, and anytime during weekends or statutory holidays -- eligibility time frames for after-hours premiums were stipulated in a "Master Agreement."
Teleradiologists had to perform a reading during required time frames and within 30 or 60 minutes of receipt of the image, the time period depending on the nature of the emergency, such as stroke, for example.
"When a diagnostic image is required to be read after-hours for emergency situations, radiologists are entitled to receive either a 25% or 100% premium on the normal fee, depending on the time the image is read," the report explained.
To claim an after-hours premium, the radiologists had to indicate the claim as emergency, perform the reading accordingly, timewise, and include dates and times on each claim. The premium was not to be applied if radiologists read after-hours for convenience.
The audit sought to determine whether Health PEI had effective processes in place to ensure after-hours premiums were paid in accordance with agreements and legislation. Focusing on payments made between April 1, 2023, and March 31, 2024, the audit found that the agency was not adequately monitoring teleradiology claims.
"Their imaging system tracked when the image was transmitted, but it was not able to verify the time the teleradiologists received the image," the report explained. "They assumed this transmission happened quickly, with minimal delays, but had not confirmed this."
Also, audit logs on the teleradiology company side were not obtained.
"In these cases, taxpayers paid more than they should have for these services," the report noted.
In addition, "13 of these claims indicated it was an emergency which required the image to be read within 60 minutes of receipt (i.e., none were for stroke patients)," the report stated. "On average, it took the teleradiologist 16 hours to read these images," even though the claims indicated the situation was an emergency because the radiologist, or designator, checked an emergency indicator field in their billing system.
Furthermore, one after-hours premium was made to a nonteleradiologist on an image ordered almost 11 months before it was scheduled.
This report highlighted the importance of having controls and procedures in place to monitor the legitimacy and accuracy of physician claim payments, including after-hours premiums paid to radiologists, according to the authors. The audit emphasized raising awareness and knowledge of applicable policies for Medicare employees, those responsible for budgeting for physicians, and those responsible for monitoring and audit functions.
In this case, vacancy of an auditor position at Health PEI may have contributed to missing the nonqualifying payments, according to the report. Also, advisory committees with jurisdiction over payments to radiologists were not actively engaged to examine issues with after-hours premiums paid.
Health PEI plans to introduce enhanced physician audit processes and procedures later this year.
Read the full report and associated recommendations for oversight here.
