The real victim in imaging center fraud

The real victim in imaging center fraud

by Gus Iversen, Editor in Chief | May 13, 2015
MRI Risk Management
The owner of a string of medical imaging centers in New Jersey made a plea deal in court this week after being charged with issuing millions of dollars in kickbacks to referring doctors. That radiologist has been sentenced to 10 years in prison with a minimum of four years before parole.

Regardless of whether or not that sentence — partially contingent on how many of the participating physicians and chiropractors he is willing to namedrop — fits the crime, the damage situations like this do to the public's opinion of health care providers is lasting.

It also shines a light on a problem that rarely makes the front page headlines: self-referral and the use of patients as currency. If patients cannot trust their doctors to make decisions on behalf of their well being, then who can they trust to make those decisions?

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Scrutiny of reimbursement makes the problem more complex as medical fortunes get re-shuffled. Legislation like the Stark Law allows government officials to crack down on unfair dealings, and health care workers need to be empowered to speak out on shady situations — but even well-intentioned providers may unwittingly wind up on the wrong side of self-referral laws.

DOTmed News spoke to the risk management team at Omnisure Consulting Group to find out how hospital employees can safeguard the integrity of their own facilities.

According to Tim Soefje, an Omnisure consultant and attorney at Stamer, Chadwick, Soefje, PLLC, most self-referral cases are more complicated than the one making waves in New Jersey.

"Self-referral laws differ dramatically from federal-to-state and state-to-state levels," cautioned Soefje "The evolving interpretations of these laws has created a serious problem of compliance even for the most wary [providers]."

Carol Marshal, another consultant from Omnisure, described herself as a strong advocate of robust Corporate Compliance Programs. She suggested the following four guidelines to help facilities ensure they remain on the right side of the law:

1. Vet the vendor: Perform criminal and civil background checks on all vendors once a year. Check the internet for news releases, Office of Inspector General findings, and civil filings in the local jurisdiction. Check personal backgrounds on the principles of the company. Always run a credit check on every company (Dun and Bradstreet).

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