The day before I started working as a law school professor, I spent most of the night in the emergency room with a sharp pain in my lower chest. My wife suspected I had simply torn a muscle, trying to act younger than my age, but a doctor friend from D.C. suggested over the telephone that it could be a collapsed lung. What a great start to a new career after leaving the Fraud Division of the Department of Justice!
One test was followed by another and soon I found myself having my first CT scan. The radiologist warned me that I would feel a warm sensation as he injected chemicals into my veins. It's a good thing he did. Without that warning, I am sure I would have screamed.
Ultimately, the CT scan ruled out everything, except a pulled muscle. It seems my wife was right. To help deflect the embarrassment, I teased my "trauma" friend in D.C. of being a "drama" doctor. Had he not suggested a possible collapsed lung, I doubt I would have been given a CT scan, unless a doctor wanted to bilk the insurer.
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It's been known to happen. I know from personal experience that getting a CT scan can be an uncomfortable ordeal, especially if you are wearing only a skimpy hospital gown. I hate to be the one to tell you this, but there are a few more things to worry about than your bottom sticking out. Some radiologists are taking more than X-rays.
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The American College of Radiology estimates that Medicare and private insurers pay $16 billion a year for unnecessary imaging tests ordered by doctors.
The Department of Justice recently accepted $7 million to settled allegations that Dr. Fred Steinberg, a board certified radiologist, overcharged Medicare for CT scans that were either not medically necessary or not actually performed. The settlement also resolves allegations that Steinberg paid kickbacks to two dozen local doctors to send him patients for CT scans.
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CT scans are not widely used because they cost up to $2,500 apiece. For Medicare to pay for it, the radiologist must demonstrate a medical need to justify the high cost. The Department of Justice alleged that Steinberg paid illegal kickbacks to a dozen doctors to send him patients who might need a CT scan. The government alleged that Steinberg billed Medicare for CT scans that were not actually performed, as well as many scans that were not medically needed.
The government estimated that the thousands of unnecessary tests by this radiologist amounted to millions of dollars of fraudulent billings to Medicare alone. Altogether, the radiologist paid back $7 million of the $33 million total he received from Medicare during a three year period to resolve allegations that he cheated Medicare.
The government investigation was initiated after a whistleblower stepped forward. Under the False Claims Act, private individuals can bring whistleblower actions for fraud on behalf of the United States and collect up to 25 percent of what is recovered. In this case, the whistleblower received a reward of $1.75 million.
It is time to pull the curtain on radiologists who take more than X-rays. If you know of this type of Medicare fraud or other ways people are cheating Medicare, do the right thing and step forward.
