X-Ray Technician Who Became Company’s Vice President Pleads Guilty to Health Care Fraud
Performed and Interpreted X-Rays and Other Tests in Lieu of Qualified Physicians and Radiologists in Scheme Involving More Than $2.5 Million in Medicare Losses
|U.S. Attorney’s Office July 17, 2014|
BALTIMORE, MD—Timothy Emeigh, age 50, of York Springs, Pennsylvania pleaded guilty today to health care fraud arising from a scheme in which insurance providers and Medicare were fraudulently billed for tests interpreted by unlicensed personnel, and for tests and services which in fact had not been provided.
The guilty plea was announced by United States Attorney for the District of Maryland Rod J. Rosenstein; Special Agent in Charge Nicholas DiGiulio, Office of Investigations, Office of Inspector General of the Department of Health and Human Services; and Special Agent in Charge Stephen E. Vogt of the Federal Bureau of Investigation.
According to his plea agreement, Emeigh was a licensed x-ray technologist in Maryland. Emeigh was not a licensed physician. Emeigh worked at Alpha Diagnostics Services beginning in 1993 as an x-ray technologist. In 1997, he was named vice president of the company’s operations.
Alpha Diagnostics was principally a portable x-ray supplier in Maryland, Delaware, Pennsylvania and Virginia. However, Alpha Diagnostics also supplied or provided portable ultrasound tests, electrocardiograms (“EKGs”), echocardiograms and Holter monitors. The majority of its clients were nursing homes, whose patients Alpha Diagnostics tested. Alpha Diagnostics was headquartered in Owings Mills, Maryland with an office in Harrisburg, Pennsylvania. Alpha Diagnostics was enrolled in the Medicare program. Medicare required that a licensed physician order and interpret the x-ray or other test, and render a formal report.
Nonetheless, in 1997, Emeigh began performing x-ray interpretations in lieu of a licensed physician or radiologist, and producing fraudulent reports using the names of actual physicians who had never seen the x-rays in question. In 2003, as technology improved, Emeigh began interpreting medical tests and writing reports in the name of registered licensed physicians from his home using his home computer. In addition to x-rays, Emeigh began interpreting and drafting fraudulent reports for ultrasounds and EKGs from his home, while traveling out of state, and at times, from overseas. Sometimes Emeigh performed medical interpretations and transmitted x-ray images using a cell phone application.
By 2010, Emeigh performed more than 70% of the x-ray interpretations, masquerading as a licensed radiologist or physician. On an average month, more than 1,000 x-ray interpretations were conducted by Alpha Diagnostics in Maryland alone.
Emeigh suggested to Alpha Diagnostics that he transmit particularly difficult medical interpretations to actual licensed physicians. If a patient caregiver contacted Alpha Diagnostics to question any of the medical interpretation reports generated by Emeigh or other unlicensed Alpha Diagnostics personnel, the diagnostic interpretation was reassigned to an actual licensed physician for a second interpretation, who would not be apprised of the first interpretation and conclusion.
Alpha Diagnostics would bill insurance providers for 2-view chest x-rays even where single-view x-rays had been ordered or performed. Alpha Diagnostics routinely submitted insurance payment claims which exaggerated the number of anatomical views performed by its x-ray and ultrasound technologists; and for multiple transportation charges on occasions when multiple patients had been examined at the same facility. Alpha Diagnostics would routinely bill Medicare for “global” x-ray procedures (i.e., both professional and technical components), along with transportation and setup charges, for studies interpreted “in-house” by Emeigh or other unlicensed Alpha Diagnostics personnel.
From January 2007 through October 2012, the financial loss to Medicare alone for the misconduct described herein was more than $2.5 million.
Emeigh faces a maximum sentence of 10 years in prison and a $250,000 fine. U.S. District Judge James K. Bredar scheduled sentencing for October 29, 2014 at 2:00 p.m.
United States Attorney Rod J. Rosenstein praised the HHS- Office of Inspector General and FBI for their work in the investigation, and thanked Assistant U.S. AttorneyMark W. Crooks, who is prosecuting the case.