Mori, Bean and Brooks: A Domestic Reread Billed as the Original

In the Mori Bean Brooks teleradiology settlement, the practice agreed to pay $1.4 million to resolve allegations that it billed Medicare and Medicaid for overseas radiology interpretations and domestic rereads presented as original work. The government alleged overseas billing from April 27, 2012, through February 5, 2019.

The second allegation is the telling one. According to the government, another radiologist in the United States reinterpreted work initially performed overseas, and the practice billed as though that domestic doctor had performed the original read. For a radiologist or routing employee, the difference sits in the work itself: who read the image first, where that person was, and how the later read became a bill.

Mori, Bean and Brooks is a radiology practice in the Jacksonville, Florida area. The Justice Department announced the settlement on November 20, 2020.

What the Teleradiology Settlement Covered

The government alleged that the practice billed Medicare and Medicaid for ineligible radiology work. The announcement described both overseas interpretations and a domestic reread billed as an original interpretation.

In the first allegation, the location of the work was the payment problem. The Justice Department explained that Medicare required teleradiology services to be performed within the United States to qualify for reimbursement. The practice allegedly billed for reads performed abroad.

In the second allegation, the government described a sequence involving another physician. Radiology services were initially performed overseas. A radiologist in the United States then reinterpreted the work. The practice allegedly billed using the domestic radiologist as if that physician had performed the original read.

The alleged arrangement put the later reader’s name on the original work. A second read did not make the first one domestic.

Why the Domestic Reread Mattered

A domestic signature at the end of that sequence does not tell its whole history. Someone looking only at the submitted claim may see a domestic physician without seeing the overseas work that preceded the reread.

Where the Read Happened and What an Insider Can See

For offshore teleradiology, we would look for where the radiologist worked when reading the image. A U.S. practice address or server location does not answer that question.

We would examine how images reached their readers, who performed the initial interpretation, what the domestic radiologist subsequently did and how the practice described that service when it billed. Reader assignments, report histories and the associated claims can connect those events.

Different employees may see different parts of it. A radiologist may know whether an assignment was an initial interpretation or a reread. A routing employee may know where the work went. A billing employee may know which physician and service appeared on the claim. We work with the insider to connect that knowledge to what the practice told Medicare or Medicaid when it billed.

For this kind of billing concern, an insider can give those records their meaning. Knowing why a report passed from one reader to another can explain a sequence that looks unremarkable on the face of a bill.

Billing Continued After the Government Gave Notice

The Justice Department said Mori, Bean and Brooks continued billing Medicare and Medicaid for reads performed outside the country until after the United States informed it of the investigation. The announcement then credited the practice’s diligent and effective cooperation with reducing the amount owed.

For an employee who knows the workflow, that account makes the timing of internal decisions relevant. We would want to understand the instructions staff received, the billing practices those instructions affected and what changed afterward. The clinical work, the claims and management’s response belong in the same account.

The Radiologist’s Whistleblower Share

A radiologist who had worked for the practice brought a qui tam case in the Middle District of Florida. The settlement announcement said the whistleblower would receive 19% of the settlement proceeds. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

BioTelemetry and CardioNet Show Another Offshore Workflow

In the separate BioTelemetry and CardioNet case, the Justice Department’s settlement announcement described allegations that federal beneficiaries’ cardiac data went to India for review and that technicians lacked required credentials. That case concerned technician review; Mori, Bean and Brooks concerned radiologists’ interpretations and domestic rereads billed as original work.

You Know Who Read the Image

If you saw overseas interpretations become domestic bills, or rereads presented as original work, talk with our whistleblower experts about the reads and claims you know. We work with you to connect the readers, reports and bills into a case and bring in healthcare fraud whistleblower lawyers who know radiology billing. We stay on your side as the case develops, from tracing the first interpretation to pursuing a recovery.