American Sleep Medicine LLC has consented to pay $15.3 million to settle a False Claims Act lawsuit against the company, alleging that it submitted ineligible claims for payment to federal healthcare programs, including Medicare, TRICARE, and the Railroad Retirement Medicare Program. According to the Department of Justice, the claims for reimbursement involved sleep diagnostic services that were not performed by a licensed technician.
American Sleep provides testing for patients struggling with obstructive sleep apnea and other sleep disorders. With headquarters located in Jacksonville, Florida, the company runs 19 diagnostic sleep testing centers in 14 states around the country.
American Sleep Filed Medicare Claims for Ineligible Sleep Tests
Doctors rely on American Sleep test results to determine how to treat their patients. The procedure most frequently used to diagnose sleep apnea is called polysomnographic diagnostic sleep testing.
For sleep testing claims to be eligible for reimbursement by federal government healthcare programs, the initial sleep studies are to be performed by a “sleep test technician” certified or licensed by a national or state credentialing body. But American Sleep allowed unlicensed technicians to administer the polysomnographic diagnostic sleep testing. Claims for reimbursement for tests performed by unqualified personnel were therefore ineligible and constituted false claims in violation of the federal False Claims Act. American Sleep filed such claims from 2004 through 2011, the government alleged.
Medicare False Claims Act Violations Brought to Light by Whistleblower
The allegations against American Sleep were initially brought to light when a whistleblower lawsuit was filed under the qui tam provisions of the False Claims Act. Private citizens who are aware of similar fraud are authorized by the statute to bring civil actions on the government’s behalf and share in a portion of monies received. The whistleblower in the American Sleep case will receive $2,601,228 as part of the settlement.
Employee Insiders Best Situated to Fight Medicare Fraud
Health care providers that overbill Medicare and other government healthcare programs drive up health care costs for everyone. Employee insiders are in the best position to notify the government when Medicare fraud occurs. Sometimes health care workers are instructed to conduct procedures for which they are not qualified. Accounting personnel may be expected to engage in unscrupulous Medicare billing practices. Health care employees are generally the first to notice irregularities.
Before coming forward, tipsters should get informed. Our lawyers at Waters & Kraus are here to provide government collaborators with the answers they need. Contact us or call our whistleblower lawyers at 800.226.9880 to find out more about our Medicare fraud practice and how we can assist you.