American Sleep Medicine LLC has agreed to 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.
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 credentialing body as sleep test technicians.
American Sleep submitted claims to Medicare and TRICARE that were false because the diagnostic testing services were performed by technicians who lacked the required credentials or certifications, when it knew this violated the law.
The whistleblower who raised these allegations in a False Claims Act lawsuit will receive $2,601,228 as a reward for exposing this fraud upon American taxpayers.
For more information on this case, click here: http://www.justice.gov/opa/pr/2013/January/13-civ-006.html