Dr. Rajahakher P. Reddy of Atlanta, GA, President of the company Reddy Solutions, Inc. (RSI) has been arraigned on "ghost-reporting" allegations. The federal charges include wire fraud, mail fraud, health care fraud, and obstruction of justice. Ghost reporting or ghost reading occurs when a radiologist passes off "reads" of images and reports as his or her own review when actually the reads are performed by someone else.

"This case shows a clear violation of the public's trust. Any time false claims are submitted for payment, our nation's health insurance programs and beneficiaries suffer. Ensuring the integrity of health care programs remains a top priority for the Inspector General and our law enforcement partners," said HHS/Office of Inspector General Acting Special Agent in Charge Carl D. Bocchicchio on the Department of Justice, Northern District of Georgia, website.

According to the indictment, Reddy and RSI claimed to have performed health care services not in fact performed. RSI is a teleradiology company that offers around-the clock professional radiology services to hospitals, imaging centers, and radiology groups. A hospital or other facility performs the X-Ray, Magnetic Resonance Image, CT Scan, or other test on-site, and then electronically transmitted the films or images to RSI or Reddy or an RSI contract radiologist to review, prepare, and send back a final report with clinical findings related to the images and the medical diagnosis. Because the patient, hospital or other RSI client may be hundreds of miles away from the RSI radiologist, the parties exchange necessary information electronically.

The indictment alleges that from May 2007 through January 2008, Reddy fraudulently signed and submitted radiology reports for approximately 40,000 patients to the hospitals and other providers who were RSI clients, however neither he nor any other RSI physician had ever reviewed and analyzed the films. Reddy had non-physician technicians known as Radiology Practice Assistants (RPAs) review the films and prepare the reports, and then Reddy passed off the RPA-prepared draft reports prepared by the RPAs as final radiology reports reviewed by a board-certified radiologist, without any actual physician review. Over 90% of the reports signed by Reddy during this period were allegedly prepared this way.

The indicted says Reddy knew the hospital or other RSI client then submitted bills to Medicare and private insurance companies for these tests, including for the assumed professional services of a qualified radiologist that never in fact occurred. RSI received over $1.5 million during this time for these specific fraudulent reports.

The indictment does not allege fraud in connection with the reports signed by any other RSI doctor. The charges carry a maximum sentence of up to 20 years in prison and a fine of up to $250,000 for each count.

The indictment only contains charges and the defendant is presumed innocent of the charges and it will be the government's burden to prove the defendant's guilt beyond a reasonable doubt at trial.

Adapted in part from a press release from the U.S. Attorney's office, Northern District of Georgia.

Link: http://www.justice.gov/usao/gan/press/2009/11-05-09.pdf

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