A case involving allegations of improper MR readings and diagnoses has become public knowledge following a request by federal prosecutors to unseal it two years after it was filed.
Brought forth by two whistleblowers, the lawsuit accuses MR reading company ProScan Imaging and its teleradiology branch, ProScan Reading, of improperly filing claims to Medicare, Medicaid and Tricare in exchange for reimbursements for MR exams interpreted by physician assistants rather than qualified doctors. It claims that such interpretations have led to frequent misdiagnoses and missed diagnoses, and cost the government millions, reported WCPO Cincinnati
“This lack of proper review has caused injury to patients whose images were mistakenly read as normal by the unlicensed readers and not properly reviewed by a qualified physician,” said the suit, which was filed in the U.S. District Court of Cincinnati. “Likewise, ProScan frequently misdiagnoses as serious — and even life-threatening — imaging findings that are of no consequence.”
Former ProScan radiology assistant Jason Taylor and radiologist Dr. Peter Rothschild filed the suit in October 2017, claiming that the company was using lower-paid physician assistants to "ghost read" exams.
Taylor, who worked in marketing and sales for the company’s Jeffersontown location in Kentucky in 2015, claims that ProScan CEO and medical director Stephen Pomeranz attempted to recruit him into a one-year, uncertified, secret training program that would teach him to be a "ghost reader". Taylor refused and chose not to renew his contract when it expired in the spring of 2016, according to the lawsuit.
Rothschild, who developed the open MR and holds an MR patent, says in the suit that he became aware of the alleged scheme at ProScan through reviewing numerous reports issued by the company, that were directed to him by physicians who had "grave concerns" about the findings.
One case he points out involved an MR scan of a jockey who claimed to be suffering neck and arm pain, headaches, numbness and tingling in both hands after a horse fell on him. No acute injury was found by ProScan, a diagnosis that shocked Rothschild, who upon reviewing the exam himself, says he found multiple life-threatening, obvious conditions, including two spinal cord injuries in the neck and a complete tear of the ligament that keeps the neck stable.
“When this ligament is torn, the patient is at very high risk of becoming paralyzed from the neck down or, worse, expiring if he sustains any further injury or trauma. These serious conditions made the patient a ticking time bomb,” he said in the suit, alleging that the injuries were missed because a physician assistant read the 200 images and was unable to identify them. He says that either a doctor who never looked at them signed the report or that someone else ghost-signed his signature, possibly without his knowledge.
Headquartered in Cincinnati, ProScan Imaging consists of 35 board-certified radiologists and operates 25 freestanding imaging centers in seven states. ProScan Reading interprets 2,000 MRs daily for 500 hospitals and imaging centers nationwide.
The whistleblowers claim it is impossible, with the number of radiologists on board, for the company to be able to read 350,000 studies annually, as it advertised in 2018. ProScan maintains that all of its reports are reviewed and finalized by licensed, board-certified physicians.
“ProScan was contacted by the DOJ over a year ago with a request for information related to the government’s investigation of the allegations of the lawsuit. ProScan responded to the DOJ's requests, shared all requested information, and fully cooperated with the investigation. After the DOJ’s thorough review and consideration of all requested information, the DOJ declined to pursue the case further," said Pomeranz and company president Michael O'Brien in a statement.
Pomeranz, who is also the founder of ProScan Reading, and Dr. Malcom Shupeck, associate medical director of ProScan and director of fellowship administration of the ProScan Imaging Education Foundation, are named as defendants.
Tyler and Rothschild have been granted permission to litigate the case in the name of the United States by the U.S. Department of Justice, which has declined to intervene so far but may do so at any time.
Unsealed by U.S. District Court Chief Judge Susan Dlott, the case has been reassigned to U.S. District Court Judge Michael Barrett.