Just Sleep This One Off? Probably Not

Federal prosecutors have filed a complaint under the False Claims Act (FCA) against Bay Area Sleep Associates LLC, dba SomnoMedics LLC, and its owner, Edward Killmer Jr. The complaint, filed in U.S. District Court for the Middle District of Florida, alleges that the defendants violated the FCA by knowingly submitting, or causing to be submitted, to the United States false claims for payments from multiple federal health care programs. 

The government’s complaint alleges that beginning no later than 2004, the defendants hired unlicensed sleep technicians to perform sleep tests at one or more of their facilities.   Medicare regulations require that diagnostic testing services performed at independent diagnostic testing facilities such as SomnoMedics must be performed by a technician licensed or certified by a state or national credentialing body in order to be reimbursed by Medicare.   The complaint alleges that SomnoMedics utilized unlicensed sleep technicians to perform sleep tests on Medicare and TRICARE beneficiaries, but knowingly requested payment for these services despite being fully aware that SomnoMedics failed to comply with federal program reimbursement regulations.
 
“Providers who participate in federal health care programs must play by the rules, not cut corners,” said Tony West, Assistant Attorney General for the Justice Department’s Civil Division.  “Billing the government for diagnostic tests performed by unlicensed technicians, as we allege here, is unfair to patients and a misuse of taxpayer dollars.”
 
The lawsuit originally was filed under the qui tam or whistleblower provisions of the FCA by William Revels, a former sleep study technician.   The United States intervened in part of the lawsuit, and has filed its own complaint.   Under the FCA, the United States may recover three times the amount of its losses plus civil penalties.