Unnecessary X-Rays—and Related Billing—Land a Physician in Prison

A physician in California has been sentenced to 7 years in prison after being convicted of ordering “excessive and medically unnecessary x-rays to healthy patients” and subsequently billing both Medicare and Medi-Cal as reported in MedPage Today. State law enforcement first caught wind that something in the practice could be amiss in 2016. Upon investigating the cases of 10 reportedly randomly selected patients, they say they found evidence of medically unnecessary x-rays and fraudulent billing. While this case appears to reveal intent on the part of the physician—hence, the severe penalty—the entire episode should be a reminder that x-rays (and tests of all kinds) must be demonstrably necessary in order to protect the integrity of your practice and to limit risk for accusations of fraud. Providers should have clear and consistent protocols as to when an x-ray is necessary, such that a survey of x-rays ordered by urgent care providers would show consistency in the numbers and types of x-ray studies performed.  X-ray is a defining feature for urgent care centers, part of the Urgent Care Association Certification criteria, that differentiates urgent care from primary care and other practice types. Keep an eye out for new articles on appropriate x-ray practices in coming issues of JUCM.