Radiology could witness ‘enforcement perfect storm’ as feds ratchet up pressure in 2021

Radiologists and other physicians might witness an “enforcement perfect storm” this year as the feds ratchet up pressure following a slowdown in 2020, experts said Monday.

COVID-19 assistance funds could be one area of scrutiny, with relief programs doling out billions of dollars to the healthcare industry to counter catastrophic losses, but offering little guidance. The pandemic slowed down the Department of Justice as recoveries dropped by 30% in the fiscal year that ended in September, falling to $2.2 billion—a 10-year low. But collections for fiscal 2021 have already surpassed last year at $4 billion and counting, Bass, Berry & Sims noted in its Healthcare Fraud & Abuse 2020 analysis.

“The early days of the pandemic may have delayed enforcement efforts somewhat, but the activity toward the end of last year and so far this year suggests the lull is over,” Matthew Curley, a member of the firm’s Healthcare Fraud Task Force and lead editor of the report, said in a statement.

Curley and colleagues highlighted several DOJ actions against radiology providers last year in the analysis. Southern California-based practice Omega Imaging Inc. topped the list for its $5 million payout to resolve allegations that it delivered contrast-enhanced exams without physician supervision and administered care at unaccredited facilities. DOJ officials similarly targeted Florida-based Advanced Imaging of Port Charlotte for physician oversight concerns and missing credentials, reaching a $501,000 agreement in September. And a third settlement in August had a Pennsylvania mobile x-ray provider ponying up $50,000 for allegedly overbilling Medicare for transportation costs.

Fiscal 2021 has already seen several more cases targeting imaging, including a $1.4 million payout from a practice that allegedly delivered teleradiology services from outside the U.S. As providers looks to remain compliant during this period of increased scrutiny, the Nashville, Tennessee-based firm recommended keeping a keen eye on relationships with referral sources. Closely monitoring quality metrics, documenting support for COVID relief funds, and staying cautious about speaking engagements are also wise, the law firm noted.

“Holding individuals accountable in healthcare fraud cases is now a well-established fraud enforcement priority,” said Lisa Rivera, a Healthcare Fraud Task Force member and former federal prosecutor, said Monday. “Making this a top leadership priority within an organization is a critical element of building and maintaining a culture of compliance,” she added later.