The owner of an Owings Mills imaging firm was accused in a federal indictment this week of contributing to the deaths of four people whose disease and infection were not caught on X-rays because employees were not qualified to read them.
Rafael Chikvashvili, the owner of Alpha Diagnostics LLC in Owings Mills and Harrisburg, Pa., had already been indicted on charges of defrauding Medicare and Medicaid of more than $7.5 million.
On Thursday, a federal grand jury added four counts of health care fraud resulting in serious bodily harm and death — a charge that carries the potential for a life sentence — according to the office of the U.S. attorney for Maryland.
Prosecutors say Chikvashvili, 67, directed employees who were not doctors to interpret X-rays, medical tests, ultrasounds and cardiological exams rather than paying licensed physicians for the assessments.
They say he also directed workers in Owings Mills and Harrisburg, Pa., to draft fake doctors' examination reports, and then forged doctor signatures himself. Prosecutors say Chikvashvili holds a doctorate in mathematics but is not a physician.
Chikvashvili's attorney said the charges have no merit.
"Our client denies all the charges, and he looks forward to contesting them in court," attorney Jonathan Biran said.
Chikvashvili was initially indicted in September, when prosecutors accused him of filing false claims to the government health programs Medicaid and Medicare from 1997 until October 2013.
The government has been pursing Medicare and Medicaid fraud more aggressively, said James Quiggle, a spokesman for the Coalition Against Insurance Fraud, a watchdog group. But it's unusual for them to try to link the activity to deaths.
Most health care providers who are accused of defrauding the government are trying to "fly under the radar," Quiggle said.
They are more likely to pad their bills or steal patients' identities and make up claims, he said, rather than actually provide substandard care — which invites scrutiny from other medical providers and law enforcement.
"Scammers in general are concerned less about rendering quality care and more about milking the system for every penny they can," Quiggle said. "You can run a fine line between shoddy health care and endangering a patient's life."
In each of the four deaths linked to Chikvashvili in the indictment, prosecutors say he and his employees missed crucial information on X-rays because they were not interpreted by a qualified radiologist. They missed congestive heart failure, pneumonia and a large pelvic mass, prosecutors say.
With proper image interpretations, they say, the patients' treatment would have been different.
In one case, prosecutors say, an employee reported seeing no chronic health conditions in the chest X-ray of a woman with congestive heart failure.
The patient died four days after the images were taken. Prosecutors say she "would have lived longer than she did" if her scans were properly assessed by a qualified radiologist and she were diagnosed and treated.
In another case, prosecutors say, a woman was cleared for surgery after Alpha Diagnostics failed to detect her congestive heart failure, a condition that can cause bleeding during surgery. Her condition worsened, prosecutors say, and she died six days after the images were taken.
In a third case, prosecutors say, an Alpha Diagnostics employee failed to report that a woman had pneumonia. She was not treated, they say, and she died five days later.
In a fourth case, prosecutors say, Alpha employees missed a mass in a woman's pelvis. She died the following day.
In each case, prosecutors say, Alpha Diagnostics billed the government for the images.
In other cases described in the indictment, prosecutors say the firm exaggerated the services performed, exceeded the services ordered by doctors, overcharged for transportation costs or made false representations that workers were supervised by physicians.
They are seeking the forfeiture of at least $7.5 million in assets, including two properties, luxury vehicles, and bank and investment accounts.
If convicted of harming a patient, Chikvashvili could face a sentence of life in prison. He could face up to 10 years for each of seven counts of health care fraud, 20 years for each of eight counts of wire fraud, up to five years for each of 11 counts of false statements related to health care matters, and two years for two counts of aggravated identity theft.
Timothy Emeigh, a former vice president in charge of operations at Alpha Diagnostics, has pleaded guilty to health care fraud and is awaiting sentencing.
Emeigh, a licensed radiologic technologist but not a doctor, is accused in the new indictment of viewing images using his personal laptop while on vacation in Jamaica and then drafting false physician interpretation reports that were later submitted to Medicare for reimbursement.
Emeigh's federal defender, Elizabeth Oyer, could not be reached for comment late Friday.
The U.S. attorney's office, the U.S. Health and Human Services Office of Inspector General and the FBI are investigating. Officials said no court date has been scheduled for Chikvashvili, and he remains on release under the supervision of U.S. Pretrial Services.
Even with increased enforcement of such cases, Quiggle doesn't expect a great increase in charges involving deaths. But the size of uncovered scams, he said, is likely to grow.
He called the $7.5 million figure in Chikvashvili's case "moderately high." Schemes involving international crime rings have reached upward of $30 million.