Saturday, July 19, 2014

Diagnostic Company’s Unlicensed Vice President Pleads Guilty To Health Care Fraud After Performing and Interpreting X-rays and Other Tests in Lieu of Qualified Physicians and Radiologists

On July 17, 2014, a licensed x-ray technician Timothy Emeigh who was a vice-president of a diagnostic company pleaded guilty to health care fraud in the District of Maryland arising from a scheme in which insurance providers and Medicare were fraudulently billed for tests interpreted by unlicensed personnel, and for tests and services which in fact had not been provided.

According to his plea agreement, Mr. Emeigh was a licensed x-ray technologist in Maryland but was not a licensed physician. Mr. Emeigh worked at Alpha Diagnostics Services beginning in 1993 as an x-ray technologist and by 1997, he was named vice president of the company’s operations.

Alpha Diagnostics was principally a portable x-ray supplier in Maryland, Delaware, Pennsylvania and Virginia. However, Alpha Diagnostics also supplied or provided portable ultrasound tests, electrocardiograms (“EKGs”), echocardiograms and Holter monitors. The majority of its clients were nursing homes, whose patients Alpha Diagnostics tested. Alpha Diagnostics was enrolled in the Medicare program. Medicare required that a licensed physician order and interpret the x-ray or other test, and render a formal report.

Nonetheless, in 1997, Mr. Emeigh began performing x-ray interpretations in lieu of a licensed physician or radiologist, and producing fraudulent reports using the names of actual physicians who had never seen the x-rays in question. In 2003, as technology improved, Mr. Emeigh began interpreting medical tests and writing reports in the name of registered licensed physicians from his home using his home computer.

In addition to x-rays, Mr. Emeigh began interpreting and drafting fraudulent reports for ultrasounds and EKGs from his home, while traveling out of state, and at times, from overseas. Sometimes Mr. Emeigh performed medical interpretations and transmitted x-ray images using a cell phone application.

By 2010, Emeigh performed more than 70% of the x-ray interpretations, masquerading as a licensed radiologist or physician. On an average month, more than 1,000 x-ray interpretations were conducted by Alpha Diagnostics in Maryland alone. Mr. Emeigh suggested to Alpha Diagnostics that he transmit particularly difficult medical interpretations to actual licensed physicians. If a patient caregiver contacted Alpha Diagnostics to question any of the medical interpretation reports generated by Mr. Emeigh or other unlicensed Alpha Diagnostics personnel, the diagnostic interpretation was reassigned to an actual licensed physician for a second interpretation, who would not be apprised of the first interpretation and conclusion.

There were other fraud allegations including one that Alpha Diagnostics would bill insurance providers for 2-view chest x-rays even where single-view x-rays had been ordered or performed. Another fraud allegation was that Alpha Diagnostics routinely submitted insurance payment claims which exaggerated the number of anatomical views performed by its x-ray and ultrasound technologists; and for multiple transportation charges on occasions when multiple patients had been examined at the same facility. Alpha Diagnostics would routinely bill Medicare for “global” x-ray procedures (i.e., both professional and technical components), along with transportation and setup charges, for studies interpreted "in-house" by Mr. Emeigh or other unlicensed Alpha Diagnostics personnel.

From January 2007 through October 2012, the financial loss to Medicare for the alleged misconduct was more than $2.5 million but this did not occur any losses to private insurance.  The statutory maximum on Mr. Emeigh’s sentence is 10 years in prison and a $250,000 fine. U.S. District Judge James K. Bredar scheduled sentencing for October 29, 2014.

Attorney Commentary: Diagnostic companies who perform tests and reports have been under scrutiny by OIG for the past eight years since diagnostic testing was targeted to the high reimbursements paid.  Audits were conducted of many diagnostic companies and once those audits were completed, some cases were referred to Office of Inspector General for criminal investigation.

There have been many cases where radiologists who had a high number of reports were suspected of having technicians write the reports but this case was extreme in that the technician used radiologists' names where the radiologist did not interpret the test. We have represented radiologists where this was done to them in part because the diagnostic company wanted to avoid paying the interpreting fee. In this case, the radiologists were not charged -- only the diagnostic company. However, the supervising physicians could have had some exposure if they knew or should have known of the misconduct. 

Posted by Tracy Green, Esq.
Green and Associates, Attorneys at Law
Phone: 213-233-2260


DISCLAIMER: Green & Associates' articles and blog postings are prepared as a service to the public and are not intended to grant rights or impose obligations. Nothing in this website should be construed as legal advice. Green & Associates' articles and blog postings may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their contents and contact their attorney for legal advice. The primary purpose of this website is not the commercial advertisement or promotion of a commercial product or service and this website is not an advertisement or solicitation. Anyone viewing this web site in a state where the web site fails to comply with all laws and ethical rules of that state, should disregard this web site.

The information provided on this website is for informational purposes only. It is not intended to create, and does not create, a lawyer-client relationship with Green & Associates, Attorneys at Law. Sending an e-mail to Tracy Green does not contractually obligate them to represent you as your lawyer, or create any type of client relationship. No attorney-client relationship will be formed absent a written engagement or retainer letter agreement signed by both Green & Associates and client and which specifies the scope of the engagement.

Please note that e-mail transmission is not secure unless it is encrypted. E-mail messages sent to Ms. Green should not include confidential or sensitive information.