Review of Alleged Mismanagement of Radiologists Interpretations at Central Arkansas Veterans Healthcare System

OIG reviewed the Central Arkansas Veterans Healthcare System (CAVHS) Teleradiology Reading Center (TRC) to determine the merits of an allegation that radiologists stopped reading exams for CAVHS patients when they had reached their minimum Relative Value Unit (RVU) level and then performed fee-basis interpretations for other VA facilities during their tours of duty under a TRC agreement. We did not substantiate the allegation that CAVHS radiologists inappropriately performed fee-basis interpretations for other Veterans Integrated Service Network (VISN) 16 medical facilities during their scheduled duty hours. Our review of 7,657 interpretations between January 1, 2014, and June 30, 2014, determined that CAVHS radiologists conducted their TRC interpretations during non-duty hours. We did not find that radiologists stopped performing radiology interpretations for CAVHS patients when they had reached their minimum production level. However, we found VISN 16 could improve their controls to add more reliability to their determinations that radiologists performed TRC interpretations during non-duty hours. Of 7,657 interpretations, we identified 384 interpretations that appeared radiologists started or accessed during duty hours. We used data not accessed by VISN staff and identified the actual time radiologists dictated their interpretation. We determined radiologists made all 384 interpretations during non-duty hours. We also found that CAVHS radiologists' timecards did not accurately show their official weekend tour of duty and VISN 16 had not reviewed the TRC agreement in the past 5 years. We recommended the Interim VISN 16 Director review the time interpretations started and ended to ensure radiologists perform TRC interpretations during their non-duty hours, establish policy on an official tour of duty for weekend duty, and require annual certification of the TRC agreement.