DOJ Pronounces Settlement with House-Well being Providers Firm Over FCA Kickback and Overbilling Allegations | Dorsey & Whitney LLP

The Division of Justice not too long ago introduced that it resolved two civil lawsuits filed beneath the qui tam, or whistleblower, provisions of the False Claims Act to the tune of almost $4 million. The fits alleged {that a} suburban Chicago diagnostics firm, SNAP Diagnostics, LLC, that gives residence testing for sleep problems was defrauding Medicare and 4 different federal well being care applications via kickbacks and pointless testing. Since Medicare started masking residence sleep testing in 2009, SNAP has acquired almost $9 million from Medicare – virtually all of it the results of fraud and kickbacks, in line with the federal government’s allegations.

As alleged by the federal government, SNAP, its founder Gil Raviv, and its vice chairman Stephen Burton violated the False Claims Act and the Anti-Kickback Statute via numerous fraudulent billing practices. Specifically, Raviv allegedly instructed SNAP to submit claims for sufferers’ second and third nights of residence sleep testing when the corporate knew they had been medically pointless as a result of solely a single evening of testing was wanted to successfully diagnose sure sleep problems.

As well as, the federal government alleged that SNAP’s enterprise mannequin relied on a number of illegal kickback schemes. First, SNAP purportedly paid commissions and bonuses to its gross sales power for promoting multi-night testing to suppliers, and it gave free residence sleep exams to physicians and their households to induce referrals.

Second, after its sleep testing was carried out, SNAP personnel allegedly interpreted the outcomes and gave unsigned studies to referring physicians who in flip would invoice as if the physicians had carried out the skilled service of decoding the outcomes themselves. This allowed suppliers to “hold” the billing for the skilled element of residence sleep testing providers. SNAP deliberately allowed physicians to fraudulently invoice for this service as a manner of accelerating referrals and driving the quantity of SNAP’s enterprise.

Different allegations in opposition to SNAP embody the pointless and illegal multiplication of the copays of federal well being care beneficiaries together with senior residents on Medicare.

The settlement requires that SNAP pay $3.5 million, Raviv pay $300,000, and Burton pay $125,000 for a complete settlement quantity of $3.925 million.

This isn’t the primary home-health providers firm to settle with the DOJ in current months (see our March 8, 2022 weblog) and serves as one more reminder to healthcare firms of the significance of inner controls and due diligence – particularly when federally-funded therapy is concerned.

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