COLUMBIA, Mo. - Harold A. Williamson Jr., M.D., vice chancellor of the University of Missouri Health System, announced today (June 1) that health system officials are making substantive changes in the School of Medicine's Department of Radiology as the result of an internal university investigation.
In addition, Williamson announced that Robert Churchill, M.D., dean of the School of Medicine, has officially announced his plans to retire and will leave the university in October.
The university retained an outside law firm to investigate possible billing fraud in the Department of Radiology in November 2011 after the U.S. Attorney's Office in Kansas City told the university that a federal investigation was under way.
"As the result of our investigation, we believe that two radiologists, Dr. Kenneth Rall and Dr. Michael Richards, violated Medicare and hospital rules by certifying that they had performed services that were actually performed by resident physicians," Williamson said.
"We were shocked and disappointed to learn about this, because any kind of fraud is entirely inconsistent with our health system's values, our mission, and our commitment to patient care," said Williamson, who has served as a physician at MU for 30 years, including 10 years as chair of MU's nationally recognized Department of Family and Community Medicine.
Williamson said the top concern of health system officials throughout the investigation was the possible impact on patients.
"Although we are in the early stages of the investigation, we have reviewed millions of lines of computer data and conducted lengthy interviews with many medical professionals. Thus far we have found no evidence that patient care was compromised," Williamson said.
Health system officials made the preliminary findings public today because "the finding of fraudulent billings was troubling enough that we felt we needed to act immediately," Williamson said.
Effective today, Dr. Kenneth Rall and Dr. Michael Richards are no longer employed with the University of Missouri Health System.
In addition to the departure of these doctors, revisions to the MU Department of Radiology's operating process will require changes to the way doctors view and report on patient images. Additional safeguards will also be built into software programs physicians use to analyze images.
"We have seen no evidence in our investigation that Dr. Churchill engaged in the conduct we saw with Drs. Rall and Richards, and which we found so concerning," Williamson said. "But, Dr. Churchill also does not want to allow distractions that will accompany this matter to delay any of the significant progress made at the medical school in recent years. Dr. Churchill has served the School of Medicine for a quarter century. Under his leadership, the medical school adopted the Baldrige criteria as its management model. As dean, Dr. Churchill has transformed graduate medical education, advanced medical research programs and has served as an ambassador for improving diversity and cultural competency for the entire campus. We thank him for his remarkable service."
In explaining how the billing fraud occurred, Williamson outlined the way radiologists typically work with other physicians to provide patient care. He said that if a patient is in the hospital and his or her doctor believes the patient needs an X-ray, the patient's doctor writes an order that the radiologist take an X-ray. The radiology department is then responsible for performing the test ordered by the doctor and reading the images created by the test, in this case, an X-ray.
Under the health system's procedures and under Medicare rules, a resident physician can read the patient's X-ray and work with the patient's doctor to incorporate results of the X-ray into the patient's care plan. Medicare rules require, however, that before Medicare will pay for the X-ray, an attending radiologist must also review the image.
"We believe these two doctors sometimes claimed that they had actually completed this second review without actually looking at the image," Williamson said.
"We don't believe any unnecessary tests were ordered, and we believe all the tests that were ordered by patients' doctors were performed properly," Williamson said. "But our commitment to quality patient care and integrity requires us to do more than simply 'believe.' For that reason, we are taking the following steps: We plan to have independent radiology experts conduct an in-depth review and advise us if additional steps are needed. If this review by independent radiology experts suggests that any patients could benefit from further image review or testing, we will directly contact these patients and their doctors.
While this review by independent radiologists is being done, any patient who is concerned should contact his or her physician. If patients want any of their radiological images reviewed again, the health system will re-read them, or if patients prefer, the health system will provide patients with their radiological images to be re-read by an outside radiologist of the patients' choosing at the University of Missouri Health System's expense.
Patients with concerns can also visit www.muhealth.org or call the health system at (888) 754-0963 from 8 a.m. to 5 p.m.