Two University of Missouri Physicians Plead Guilty to Health Care Fraud
JEFFERSON CITY, Mo. – Tom Larson, Acting United States Attorney for the Western District of Missouri, announced today that two physicians at the University of Missouri School of Medicine in Columbia, Mo., have pleaded guilty in federal court, in separate cases, to engaging in a health care fraud scheme that totaled more than $190,000.
Kenneth Loem Rall, 82, and Michael Edward Richards, 65, both of Columbia, Mo., each waived his right to a grand jury and pleaded guilty before U.S. Magistrate Judge Matt J. Whitworth on Tuesday, July 18, 2017, to a federal information that charges him with one count of health care fraud.
Rall, who was employed at the university from July 1, 1998, until June 1, 2012, was chairman of the department of radiology at the School of Medicine until his resignation from that position on Dec. 20, 2011. Richards, who was head of mammography, was employed at the university from July 10, 2003, to June 1, 2012. Rall and Richards were both attending physicians in the university hospital, and teaching physicians and members of the faculty of the School of Medicine.
By pleading guilty, Rall and Richards each admitted that he signed interpretations of exams performed by residents at the hospital without actually viewing the images. Rall admitted that he caused more than $120,000 in fraudulent claims to be filed with federal health benefit programs from March 2010 through December 2011. Richards admitted that he caused more than $70,000 in fraudulent claims to be filed with federal health benefit programs from March 2010 through December 2011.
Federal health benefit programs (such as Medicare, Medicaid and Tricare) pay for the interpretation of diagnostic radiology and other diagnostic tests only if the interpretation is performed or reviewed by a teaching physician. If a resident prepares and signs the interpretation, the teaching physician must indicate that he or she personally viewed the relevant images and agrees with the resident’s interpretation, or edits the findings.
Rall and Richards admitted they falsely certified that they had viewed hundreds of files and records, when in fact they did not view the images. In each instance, the federal health benefit plan caused money to be paid, relying on their certification that they had done the work required by the pertinent regulations.
Under federal statutes, Rall and Richards are each subject to a sentence of up to 10 years in federal prison without parole. The maximum statutory sentence is prescribed by Congress and is provided here for informational purposes, as the sentencing of the defendant will be determined by the court based on the advisory sentencing guidelines and other statutory factors. A sentencing hearing will be scheduled after the completion of a presentence investigation by the United States Probation Office.
These cases are being prosecuted by Assistant U.S. Attorneys Lawrence E. Miller and Cindi S. Woolery. They were investigated by the U.S. Department of Health and Human Services – Office of the Inspector General, the Defense Criminal Investigative Service and the FBI.