American Sleep Medicine LLC, Jacksonville, Fla, agreed to pay $15,301,341 to resolve allegations that it billed Medicare, TRICARE, and the Railroad Retirement Medicare Program for sleep diagnostic services that were not eligible for payment, according to the US Department of Justice.
American Sleep owns and operates 19 diagnostic sleep testing centers in 14 states and provides polysomnographic diagnostic sleep testing for patients suffering from sleep disorders such as obstructive sleep apnea (OSA).
The Justice Department alleged that American Sleep submitted claims to Medicare and TRICARE between January 1, 2004 and December 31, 2011 that were based on testing performed by technicians who lacked the required credentials or certifications.
Under federal reimbursement requirements, only licensed or certified sleep test technicians may conduct initial sleep studies. The DOJ alleged that American Sleep submitted the claims knowing that they violated the law.
“Medicare patients and military families deserve to be treated by appropriately credentialed professionals when seeking medical care,” said Stuart F. Delery, principal deputy assistant attorney general for the Justice Department’s Civil Division. “When companies providing those services seek to skirt the rules, there will be a steep price to pay.”
In addition to the $15.3 million payment, American Sleep entered into a five-year Corporate Integrity Agreement with the Office of Inspector General of the Department of Health and Human Services. The agreement requires enhanced accountability and wide-ranging monitoring activities conducted by both internal and independent external reviewers.
The allegations against American Sleep were initially raised in a lawsuit filed under the qui tam (or whistleblower) provisions of the False Claims Act, which allows private citizens with knowledge of fraud to bring civil actions on behalf of the United States and share in any recovery. The citizen filing the lawsuit, Daniel Purnell, will receive $2.6 million as part of the settlement.
Since January 2009, the False Claims Act has allowed the federal government to recover $10.1 billion in cases involving fraud against federal health care programs, according to the Justice Department.