The federal government recently settled a $15.3 million False Claims Act (FCA) case against American Sleep Medicine LLC, according to a recent Justice Department press release. In particular, American Sleep Medicine will pay $15,301,341 to resolve allegations that it billed Medicare, TRICARE (the health care program for Uniformed Service members), retirees and their families worldwide, and the Railroad Retirement Medicare Program, for sleep diagnostic services that were not eligible for payment.
According to the release, American Sleep, headquartered in Jacksonville, Florida, “owns and operates 19 diagnostic sleep testing centers throughout the United States, including in Alabama, California, Delaware, Florida, Illinois, Indiana, Kansas, Kentucky, Maryland, Missouri, New Jersey, Tennessee, Texas and Virginia.”
The company’s main purpose is to provide testing for patients suffering from sleep disorders such as obstructive sleep apnea. Doctors use the test results to determine the most appropriate course of treatment for patients.
The most common tool used to diagnose sleep disorders, particularly sleep apnea, is a procedure called polysomnographic diagnostic sleep testing.
Under federal program requirements for the reimbursement of claims submitted for sleep disorder testing, initial sleep studies must be conducted by technicians who are licensed or certified by a state or national credential body, as a sleep test technician.
Federal officials alleged that Medicare and TRICARE claims submitted by American Sleep during this period were false because according to the allegations, the government was improperly billed because diagnostic testing services were performed by technicians who lacked the required credentials or certifications, when American Sleep knew this violated the law.
The allegations were made in a lawsuit against American Sleep under the qui tam (whistleblower) provisions of the False Claims Act. The whistleblower, Daniel Purnell, will receive $2,601,228 for bringing the case to the government’s attention and filing the lawsuit. Also, as part of the deal, American Sleep entered into a Corporate Integrity Agreement with the Office of Inspector General of the Department of Health and Human Services, which requires “enhanced accountability and wide-ranging monitoring activities conducted by both internal and independent external reviewers.”
Feel free to contact one of our Gacovino Lake attorneys at 1-800-246-HURT (4878).