The head of a medical diagnostics company has been sentenced to 10 years in prison for committing health care fraud that led to two deaths.

U.S. District Judge James K. Bredar delivered the sentence to Rafael C., the CEO of Alpha Diagnostics LLC. The 10-year sentence is to be followed by two years of supervised release.

In addition to the two deaths, Rafael was found responsible for over $6 million in false billings to the Medicare and Medicaid programs.

In February 2016, a jury convicted Rafael of two counts of health care fraud resulting in death, nine counts of health care fraud, eight counts of wire fraud, one count of conspiracy, two counts of aggravated identity theft, and eleven counts of false statements relating to health care matters.

“The jury found that two patients died because their X-rays were not reviewed by a qualified radiologist,” commented U.S. Attorney Rod J. Rosenstein. “Health care fraud has consequences, in money wasted and lives lost.”

Alpha Diagnostics was a provider of portable diagnostics services. The company provided mainly X-ray services, in addition to ultrasound services and cardiologic exams.

The Maryland-based company operated at facilities from Virginia to Delaware. Clients of the company included nursing homes with patients covered by Medicare and Medicaid.

Both deaths resulted from Alpha Diagnostics failing to have a qualified radiologist review their X-rays, according to the U.S. Justice Department. In the case of the first death, the X-rays were reviewed by non-physician Alpha Diagnostics employees who failed to spot congestive heart failure.

The patient was then not transferred to an acute care facility for treatment, as would have been standard medical practice. She died four days after Alpha Diagnostics personnel misread her X-ray.

According to evidence submitted at trial, her symptoms could have been addressed if the condition had been properly identified.

The second death occurred when unqualified Alpha Diagnostics employees misread another X-ray showing congestive heart failure in a patient scheduled for elective surgery.

The patient was erroneously cleared for surgery, despite the elevated risk of bleeding caused by her heart failure. She experienced significant bleeding after her surgery, and her congestive heart failure worsened.

She died six days after the misinterpretation of her X-ray by Alpha Diagnostics personnel.

Alpha Diagnostics billed Medicare for both X-rays, falsely claiming they had been interpreted by licensed radiologists.

Fighting Health Care Fraud Through a Whistleblower Lawsuit

While criminal prosecution is left to the Department of Justice, private individuals with evidence of health care fraud can initiate civil actions through the qui tam provisions of the False Claims Act.

These qui tam actions, or whistleblower lawsuits, have been effective ways of exposing fraud committed against the U.S. government, particularly in defense contracting and more recently within the Medicare and Medicaid systems.

Once filed, a qui tam case stays under seal while the government investigates the allegations. If the claim has merit, the government will intervene in the lawsuit, essentially taking over the plaintiff’s case while keeping the plaintiff involved.

Plaintiffs in a successful whistleblower lawsuit will get a share of the money recovered – usually 15 to 20 percent, but sometimes as high as 30 percent. They also get protection from retaliatory acts by employers.