Allegedly Billing Medicare for Unnecessary Home Sleep Tests

[nitpicker]

https://www.justice.gov/usao-ndil/pr/united-states-files-suit-against-north-suburban-diagnostics-company-allegedly-billing

Department of Justice
U.S. Attorney’s Office
Northern District of Illinois

FOR IMMEDIATE RELEASE
Tuesday, December 19, 2017

United States Files Suit Against North Suburban Diagnostics Company for Allegedly Billing Medicare for Unnecessary Home Sleep Tests

CHICAGO — The United States has filed a civil lawsuit accusing a north suburban diagnostics company of defrauding Medicare out of millions of dollars through kickbacks and unnecessary home sleep testing. The suit alleges that SNAP DIAGNOSTICS LLC, its founder, GIL RAVIV, and its marketing vice president, STEPHEN BURTON, violated the federal False Claims Act by fraudulently billing Medicare for medically unnecessary services and for services that were occasioned by kickbacks. The suit alleges that Raviv directed SNAP to submit claims for Medicare recipients’ second and third nights of home sleep testing when, in fact, the company knew that only a single night of testing was needed to effectively diagnose obstructive sleep apnea and it routinely tested and claimed only the one night for non-Medicare beneficiaries. SNAP’s business model also relied on several unlawful kickback schemes, which incentivized physicians and their staffs to refer all of their home sleep testing services to SNAP, the suit alleges.

The government’s complaint was filed Monday in U.S. District Court in Chicago. On Oct. 18, 2017, the government notified the Court that it was intervening in two separate lawsuits, each initially filed under seal by a private citizen pursuant to the qui tam, or whistleblower, provisions of the False Claims Act.
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Wheeling-based SNAP is a nationwide provider of home sleep testing diagnostic services. SNAP’s home sleep tests are covered by Medicare when medically necessary to diagnose obstructive sleep apnea, a common disorder in which airflow is obstructed during sleep. Home sleep testing utilizes a portable monitor, unattended and initiated by the patient, to collect information about breathing and oxygen levels while the patient sleeps at home. The testing assists physicians in diagnosing apnea and establishing a treatment plan.

According to the government’s lawsuit, SNAP paid commissions and bonuses to its sales force for selling the multi-night testing to providers, and it gave free home sleep tests to physicians and their families to induce referrals. After the testing was performed, SNAP personnel interpreted the results and gave unsigned reports to referring physicians, who in turn would bill as if the physicians had performed the professional service of interpreting the results themselves, the suit states. The suit contends that SNAP intentionally allowed physicians to fraudulently bill for this service as a way of increasing referrals and driving the volume of SNAP’s business.

Since Medicare began covering home sleep testing in 2009, SNAP has received nearly $9 million from Medicare, almost all of it the result of fraud and kickbacks, according to the suit.
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