An internal investigation of possible Medicare fraud at the University of Missouri has resulted in two radiologists leaving the university and the dean of the school of medicine announcing his retirement. The radiologists are suspected of billing Medicare for imaging studies they never reviewed.
In a June 1 statement, the university said that it believed that two radiologists, Dr. Kenneth Rall and Dr. Michael Richards, violated Medicare and hospital rules by certifying that they had performed services that were actually performed by resident physicians, according to Dr. Harold Williamson Jr., vice chancellor of the University of Missouri Health System.
"We were shocked and disappointed to learn about this, because any kind of fraud is entirely inconsistent with our health system's values, our mission, and our commitment to patient care," Williamson said in a statement.
Rall and Richards were no longer employed with the university as of June 1, according to Public Relations Manager Mary Jenkins.
As reported on AuntMinnie.com on January 20, internal audits conducted by the hospital's Office of Corporate Compliance in 2011 revealed that 62.5% of radiological services involving Medicare patients lacked proper physician orders to support the services provided.
That finding -- and a call from the U.S. Attorney's Office in Kansas City telling the university that a federal investigation was under way -- set in motion a university investigation beginning in November to examine the department's billing practices. That investigation continues, Jenkins told AuntMinnie.com by telephone.
"Our internal investigation is ongoing, and we're in the early stages," Jenkins said. "We felt like we had to make the preliminary findings public because thus far in the investigation, the finding of fraudulent billings was troubling enough that we felt we needed to act immediately."
The allegedly fraudulent billings occurred when Rall and Richards failed to review images after their initial examination by resident physicians, according to the June 1 statement.
Typically, a patient's doctor writes an order for an imaging exam, which is the radiology department's responsibility to acquire and interpret, Williamson said in the statement. Hospital and Medicare rules allow resident physicians to read the exam and work with the patient's doctor to incorporate the results into the patient's management. However, Medicare rules require that an attending radiologist also review the image.
"We believe these two doctors sometimes claimed that they had actually completed this second review without actually looking at the image," Williamson said in the statement.
Williamson said he doesn't believe any unnecessary tests were ordered, and that all exams were performed properly. However, the hospital is planning to hire independent radiology experts to conduct an in-depth review and advise the hospital if any additional steps are needed. If the review shows that patients could benefit from further imaging review or testing, the hospital will directly contact those patients and doctors, Williamson said.
While the review is being conducted, patients with concerns should contact their physicians, the hospital stated. In addition, the hospital promised to reread any images that patients want re-examined, or provide for an outside radiologist of the patient's choosing at the university's expense. Patients with concerns are also invited to contact the health system at 888-754-0963.
In a related development, Dr. Robert Churchill, dean of the university's School of Medicine, announced his plans to retire in October, though Williamson said Churchill was not involved in the allegedly fraudulent activity.
"We have seen no evidence in our investigation that Dr. Churchill engaged in the conduct we saw with Drs. Rall and Richards, which we found so concerning," Williamson said. "But Dr. Churchill also does not want to allow distractions that will accompany this matter to delay any of the significant progress made at the medical school in recent years."
