Malpractice issues in radiology: medicare compliance versus standard of care conformance--real or imaginary conflict?

Plaintiff's Attorney (Pl Att:: Doctor, the record shows that the patient was referred to the hospital's radiology department by her gynecologist for a screening mammogram. The record also shows that when completing the mammography information form, the patient wrote that she had a lump in her left breast, correct? Defendant Radiologist (Df Ra:): Yes. Pl Att: But your technologist performed, and you interpreted, a screening mammogram. Doesn't the radiology standard of care require you to do a diagnostic mammogram when the patient has a breast lump? Df Ra:: Well, normally yes, but if it's going to be a diagnostic mammogram, then the referring physician has to order it. In this case our tech called the gynecologist and asked him whether he wanted to order a diagnostic study, and he said no, he didn't feel the lump, and that we should only do a plain screening mammogram. Pl Att:: Please explain something. You're agreeing that a woman with a breast lump should have a diagnostic mammogram, but you are saying that you didn't do one because the patient's physician wouldn't order it? Don't you have a duty to do the diagnostic mammogram in a case like this on your own, without having to ask permission from the patient's gynecologist? Df Ra:: Only the treating physician can change a screening mammogram into a diagnostic mammogram, and I am not the treating physician. If I went ahead and did a diagnostic mammography examination on my own, it would be Medicare fraud, and our hospital's compliance officer says it could result in our hospital being fined and thrown out of the Medicare program. Pl Atty: What prevents you then from recommending-not ordering, but just recommending-a diagnostic mammogram in your report, because the patient says she's got a lump? Df Rad: Well, according to our hospital's compliance officer, that would also be fraud.