Teleradiology is becoming more and more common. This technology involves transmitting images, such as x-rays, CT scans, MRIs, and ultrasounds, over the internet to a radiologist at another location to read and interpret. In many cases, this allows radiologists to work from home or other remote locations. And in some cases, radiologists in non-local time zones can help out on urgent issues that develop overnight in distant locations.

So far so good. But what if the radiologist is in another country? In fact, radiology reads have been outsourced to many locations around the world in recent years. India, Australia, Brazil, Switzerland, and Israel are common sources. Many have referred to this practice as “nighthawk” teleradiology.

Leaving aside licensing and qualifications issues, one larger issue remains: will Medicare pay for this?  And are claims submitted to Medicare for radiology services provided overseas legitimate? The answer seems to be no. Services provided outside the United States are generally not reimbursable by Medicare. In fact, the CMS Manual uses a teleradiologist based in India as an example, saying Medicare will not pay for reads done by that radiologist.

One potential end-run around this prohibition involves “ghost reading,” where an overseas radiologist actually reads the images (and is paid far less for it than a U.S.-based radiologist would be), yet a U.S.-based radiologist signs off on the read. This practice, which involves no real readings/interpretations by the U.S. doctor, is fraught with potential problems, including the potential for a False Claims Act violation for submitting false claims to Medicare. The literature, including articles from the American College of Radiology, remains unclear about the prevalence of this slippery practice.